Healthcare Provider Details

I. General information

NPI: 1124192851
Provider Name (Legal Business Name): DAURIE SMITHLINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 E MABEL ST
TUCSON AZ
85719-4348
US

IV. Provider business mailing address

2339 E MABEL ST
TUCSON AZ
85719-4348
US

V. Phone/Fax

Practice location:
  • Phone: 520-979-1895
  • Fax:
Mailing address:
  • Phone: 520-979-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number19994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: