Healthcare Provider Details

I. General information

NPI: 1336110576
Provider Name (Legal Business Name): TRENT H. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N 32ND ST SUITE 140
PHOENIX AZ
85018-3953
US

IV. Provider business mailing address

4400 N 32ND ST SUITE 140
PHOENIX AZ
85018-3953
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-4424
  • Fax: 602-254-6036
Mailing address:
  • Phone: 602-254-4424
  • Fax: 602-254-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number44833
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number36091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: