Provider Demographics
NPI:1609211291
Name:CLARISA I. SMITH, MD PLLC
Entity Type:Organization
Organization Name:CLARISA I. SMITH, MD PLLC
Other - Org Name:YAVAPAI PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-431-1152
Mailing Address - Street 1:111 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3311
Mailing Address - Country:US
Mailing Address - Phone:602-431-1152
Mailing Address - Fax:602-431-2149
Practice Address - Street 1:3001 N MAIN ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1216
Practice Address - Country:US
Practice Address - Phone:928-458-5470
Practice Address - Fax:928-458-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty