Provider Demographics
NPI:1770589814
Name:SMITH, DELL P (MD)
Entity type:Individual
Prefix:DR
First Name:DELL
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3049
Mailing Address - Country:US
Mailing Address - Phone:208-735-8386
Mailing Address - Fax:
Practice Address - Street 1:1880 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3049
Practice Address - Country:US
Practice Address - Phone:208-735-8386
Practice Address - Fax:208-735-0434
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7155208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF29517Medicare UPIN
ID1136829Medicare PIN