Provider Demographics
NPI:1629087143
Name:SMITH, KATHY W (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:6837 N ORACLE RD
Mailing Address - Street 2:#14
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4222
Mailing Address - Country:US
Mailing Address - Phone:520-297-7001
Mailing Address - Fax:520-297-7002
Practice Address - Street 1:6837 N ORACLE RD
Practice Address - Street 2:#14
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4222
Practice Address - Country:US
Practice Address - Phone:520-297-7001
Practice Address - Fax:520-297-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ312692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ907983Medicaid
AZ030111AI23502OtherSECTION FNEP
AZ907983Medicaid
AZZ100465Medicare PIN
AZI23502Medicare UPIN