Provider Demographics
NPI:1639251887
Name:SMITH, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:651-772-3461
Mailing Address - Fax:651-772-2605
Practice Address - Street 1:UFP PHALEN VILLAGE CLINIC
Practice Address - Street 2:1414 MARYLAND AVE EAST
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-772-3461
Practice Address - Fax:651-772-2605
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-01745OtherMEDICA PRIMARY
MN1000658OtherPREFERRED ONE
MN1027633OtherARAZ
MN15F32SMOtherBLUE CROSS BLUE SHIELD
MN01-01745OtherMEDICA CHOICE
MN108888OtherUCARE
MNHP17174OtherHEALTH PARTNERS
MN15F32SMOtherBLUE CROSS BLUE SHIELD