Healthcare Provider Details

I. General information

NPI: 1164506978
Provider Name (Legal Business Name): STEPHEN H SMYTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

2701 E ELVIRA RD
TUCSON AZ
85706-7124
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-4135
  • Fax: 520-874-7048
Mailing address:
  • Phone: 520-874-4135
  • Fax: 520-874-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number15464
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: