Healthcare Provider Details

I. General information

NPI: 1295149060
Provider Name (Legal Business Name): PADGET ELIZABETH SMITH SKOGMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PADGET ELIZABETH SMITH

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE # LEVEL4
CEDAR RAPIDS IA
52403-1251
US

IV. Provider business mailing address

701 10TH ST SE # LEVEL4
CEDAR RAPIDS IA
52403-1251
US

V. Phone/Fax

Practice location:
  • Phone: 319-861-7900
  • Fax: 318-861-7950
Mailing address:
  • Phone: 319-861-7900
  • Fax: 319-861-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-44894
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: