Healthcare Provider Details

I. General information

NPI: 1013980473
Provider Name (Legal Business Name): JAMES SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E GUADALUPE RD #115
GILBERT AZ
85234-5114
US

IV. Provider business mailing address

6301 S MCCLINTOCK DR #101
TEMPE AZ
85283-3392
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-2300
  • Fax: 480-214-2300
Mailing address:
  • Phone: 480-214-2300
  • Fax: 480-214-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14623
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: