Provider Demographics
NPI:1942676598
Name:ROBERT F. SMITH, MD, PLLC
Entity Type:Organization
Organization Name:ROBERT F. SMITH, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-866-2473
Mailing Address - Street 1:124 N COSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8101
Mailing Address - Country:US
Mailing Address - Phone:208-866-2473
Mailing Address - Fax:
Practice Address - Street 1:320 N COLLINS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4519
Practice Address - Country:US
Practice Address - Phone:208-866-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF35329Medicare UPIN
ID20000365Medicare PIN