Provider Demographics
NPI:1659316446
Name:SHIRLEY S SMITH M D PLLC
Entity Type:Organization
Organization Name:SHIRLEY S SMITH M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-395-0718
Mailing Address - Street 1:3219 E CAMELBACK RD STE 188
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2307
Mailing Address - Country:US
Mailing Address - Phone:026-432-5971
Mailing Address - Fax:602-267-8189
Practice Address - Street 1:3219 E CAMELBACK RD STE 188
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2307
Practice Address - Country:US
Practice Address - Phone:602-395-0718
Practice Address - Fax:602-277-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS20739207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096265Medicaid
AZ096265Medicaid
AZZ71792Medicare PIN