Provider Demographics
NPI:1700864436
Name:SMITH-TRYON, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SMITH-TRYON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1990 MCCULLOCH BLVD N
Mailing Address - Street 2:SUITE D-126
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5749
Mailing Address - Country:US
Mailing Address - Phone:928-680-4233
Mailing Address - Fax:928-680-6522
Practice Address - Street 1:2082 MESQUITE AVE
Practice Address - Street 2:STE 106
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6710
Practice Address - Country:US
Practice Address - Phone:928-680-4233
Practice Address - Fax:928-680-6522
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ35026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ150379OtherMEDICARE GROUP PTAN
AZZ150380OtherMEDICARE INDIVIDUAL PTAN
AZZ150380OtherMEDICARE INDIVIDUAL PTAN