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NPI Code Detail

MEDICARE: DR. WESLEY LINCOLN SMITH D.O.

MEDICARE: DR. WESLEY LINCOLN SMITH D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician2616AZ
22084F0202XForensic Psychiatry Physician2616AZ
32084P0800XPsychiatry Physician2616AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0724670OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841358223
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WESLEY LINCOLN SMITH D.O.
Provider Business Mailing Address
First Line : 2500 E VAN BUREN ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-6037
Country : US
Telephone Number : 480-695-6625
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E VAN BUREN ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-6037
Country : US
Telephone Number : 480-695-6625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 03/17/2018

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