Healthcare Provider Details

I. General information

NPI: 1922072941
Provider Name (Legal Business Name): JAMES C SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES C SMITH

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NICOLLET AVE S MAIL STOP 31500A
BLOOMINGTON MN
55420-2824
US

IV. Provider business mailing address

8600 NICOLLET AVE S 31500A
BLOOMINGTON MN
55420-2824
US

V. Phone/Fax

Practice location:
  • Phone: 952-887-6600
  • Fax: 952-886-7015
Mailing address:
  • Phone: 952-887-6600
  • Fax: 952-886-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20246
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: