Provider Demographics
NPI:1821085473
Name:SMITH, KRIS A (MD)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-7750
Mailing Address - Fax:602-406-6398
Practice Address - Street 1:2910 N 3RD AVE # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:602-406-7750
Practice Address - Fax:602-406-6398
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24215207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347006Medicaid
AZZ14WCJBP12Medicare PIN
G31773Medicare UPIN