Provider Demographics
NPI:1891765442
Name:SMITH, STEPHEN T (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:645 E MISSOURI AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8917
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-744-4765
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-03-19
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Provider Licenses
StateLicense IDTaxonomies
AZ23258207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00417054OtherMEDICARE RAILROAD
AZ316085Medicaid
AZZ84366Medicare PIN
AZP00417054OtherMEDICARE RAILROAD