Provider Demographics
NPI:1407821929
Name:SMITH, MATTHEW W (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8022
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-8022
Mailing Address - Country:US
Mailing Address - Phone:480-636-1149
Mailing Address - Fax:480-452-0998
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:INFECTION CONTROL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-667-4438
Practice Address - Fax:602-546-0834
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2019-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ316392080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ789860Medicaid
AZ789860Medicaid
AZG96500Medicare UPIN