Provider Demographics
NPI:1336110576
Name:SMITH, TRENT H (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N 32ND ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3953
Mailing Address - Country:US
Mailing Address - Phone:602-254-4424
Mailing Address - Fax:602-254-6036
Practice Address - Street 1:4400 N 32ND ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3953
Practice Address - Country:US
Practice Address - Phone:602-254-4424
Practice Address - Fax:602-254-6036
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44833207RR0500X
AZ36091207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN070991300Medicaid
AZ253613Medicaid
H65532Medicare UPIN
Z139962Medicare PIN
MN660000194Medicare ID - Type Unspecified
MN110238040Medicare ID - Type UnspecifiedRAILROAD
AZ2118275Medicare PIN
AZZ139964Medicare PIN