Provider Demographics
NPI:1720199615
Name:SMITH, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1624 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4212
Mailing Address - Country:US
Mailing Address - Phone:801-266-7200
Mailing Address - Fax:801-266-7004
Practice Address - Street 1:1624 E 4500 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4212
Practice Address - Country:US
Practice Address - Phone:801-266-7200
Practice Address - Fax:801-266-7004
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT183641-1205207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine