Provider Demographics
NPI:1760825533
Name:SMITH, ANDREA R (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BROADWAY ST FL 4
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4008
Mailing Address - Country:US
Mailing Address - Phone:406-327-1900
Mailing Address - Fax:406-327-1974
Practice Address - Street 1:500 W BROADWAY ST FL 4
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-327-1900
Practice Address - Fax:406-327-1974
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101261098207R00000X
MT67175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine