Provider Demographics
NPI:1427018290
Name:SMITH, RUSSELL A (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9600 S 1300 E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3766
Mailing Address - Country:US
Mailing Address - Phone:801-571-7777
Mailing Address - Fax:801-523-1848
Practice Address - Street 1:9600 S 1300 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3766
Practice Address - Country:US
Practice Address - Phone:801-571-7777
Practice Address - Fax:801-523-1848
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4938616-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012472Medicare PIN