Provider Demographics
NPI:1982654257
Name:SMITH, STEPHEN DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:#115
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-728-4292
Mailing Address - Fax:406-728-5770
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:#115
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT4309207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0043563Medicaid
MTD96202Medicare UPIN