Provider Demographics
NPI:1407837974
Name:SMITH, ROGER STUART (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:STUART
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-0104
Mailing Address - Country:US
Mailing Address - Phone:978-774-7243
Mailing Address - Fax:978-774-7421
Practice Address - Street 1:4403 HARRISON BLVD STE 2600
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3277
Practice Address - Country:US
Practice Address - Phone:801-442-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9071932-89042084S0012X
MA1584002084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28437OtherBCBS OF MA
MAA37447Medicare PIN
MAJ28437OtherBCBS OF MA