Healthcare Provider Details

I. General information

NPI: 1285600635
Provider Name (Legal Business Name): DONNA SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE. # 400
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

1760 E RIVER RD STE. # 350
TUCSON AZ
85718-5877
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4868
  • Fax: 602-230-9350
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number36091539
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number46026
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: