Provider Demographics
NPI:1598846826
Name:SMITH, CAMILLE (DO)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 N HAVEN DR
Mailing Address - Street 2:STE 101
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5788
Mailing Address - Country:US
Mailing Address - Phone:208-733-1112
Mailing Address - Fax:208-732-1212
Practice Address - Street 1:370 N HAVEN DR
Practice Address - Street 2:STE 101
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5788
Practice Address - Country:US
Practice Address - Phone:208-733-1112
Practice Address - Fax:208-732-1212
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-2146207Q00000X
IDO-0503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine