Healthcare Provider Details

I. General information

NPI: 1366071094
Provider Name (Legal Business Name): ANDREW DILLON SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 W OVERLAND RD
BOISE ID
83709-1645
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-954-8711
  • Fax: 208-375-2217
Mailing address:
  • Phone: 208-514-2500
  • Fax: 208-375-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101027591
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9571956
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: