Healthcare Provider Details

I. General information

NPI: 1750361200
Provider Name (Legal Business Name): TAMMY LYNN SMITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY SMITH GERSTENFELD

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N LIBERTY ST STE 206
BOISE ID
83704-8729
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number20A 5345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number7771968
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: