Healthcare Provider Details

I. General information

NPI: 1174211197
Provider Name (Legal Business Name): AUSTIN TYLER SMARSH DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 T W ALEXANDER DR
RALEIGH NC
27617-8768
US

IV. Provider business mailing address

8001 T W ALEXANDER DR
RALEIGH NC
27617-8768
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-0963
  • Fax:
Mailing address:
  • Phone: 919-350-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4063
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: