Provider Demographics
NPI:1780695007
Name:SMITH, J PATRICK (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:775 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7314
Practice Address - Country:US
Practice Address - Phone:952-944-2519
Practice Address - Fax:952-944-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-11
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Provider Licenses
StateLicense IDTaxonomies
MN24520207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
969990824013OtherPREFERREDONE
73B26SMOtherBLUECROSS BLUESHIELD
HP14427OtherHEALTHPARTNERS
912996OtherMEDICA
A96467Medicare UPIN