Healthcare Provider Details

I. General information

NPI: 1306404579
Provider Name (Legal Business Name): MATHEW VAN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3430
  • Fax:
Mailing address:
  • Phone: 602-954-6228
  • Fax: 602-957-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number61832
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: