Provider Demographics
NPI:1821278896
Name:SMITH, EDWARD ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 E HACKAMORE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4003
Mailing Address - Country:US
Mailing Address - Phone:602-418-9300
Mailing Address - Fax:480-247-5493
Practice Address - Street 1:2036 E HACKAMORE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4003
Practice Address - Country:US
Practice Address - Phone:602-418-9300
Practice Address - Fax:480-247-5493
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine