Provider Demographics
NPI:1861681611
Name:SMITH, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
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 1:6348 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8732
Mailing Address - Country:US
Mailing Address - Phone:208-377-4400
Mailing Address - Fax:208-377-4416
Practice Address - Street 1:6348 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8732
Practice Address - Country:US
Practice Address - Phone:208-377-4400
Practice Address - Fax:208-377-4416
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-106312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine