Provider Demographics
NPI:1841428240
Name:SMITH, JOEL (LMT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SHEPARD LN STE 102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3934
Mailing Address - Country:US
Mailing Address - Phone:801-447-8680
Mailing Address - Fax:801-447-4211
Practice Address - Street 1:630 SHEPARD LN STE 102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3934
Practice Address - Country:US
Practice Address - Phone:801-447-8680
Practice Address - Fax:801-447-4211
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73116804701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist