Healthcare Provider Details

I. General information

NPI: 1194479048
Provider Name (Legal Business Name): MATTHEW W SMITH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 480-213-7142
  • Fax: 480-213-7142
Mailing address:
  • Phone: 480-213-7142
  • Fax: 480-213-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SMITH
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 480-213-7142