MEDICARE: ROBERT SMITH

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
1	2355S0801X	Speech-Language Assistant	6498	AZ

General Provider Information

NPI Number	:	1962734863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SMITH

Provider Business Mailing Address
First Line	:	7638 W ORANGEWOOD AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-1517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19871 W FREEMONT RD
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-9512
Country	:	US
Telephone Number	:	623-474-6671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/05/2010

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Directions to “ ROBERT SMITH ” Practice Location

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