Healthcare Provider Details

I. General information

NPI: 1518923119
Provider Name (Legal Business Name): STEPHEN P. SMITH JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BUCKLES CT N STE 210
GAHANNA OH
43230
US

IV. Provider business mailing address

725 BUCKLES CT N STE 210
GAHANNA OH
43230-6884
US

V. Phone/Fax

Practice location:
  • Phone: 614-245-4263
  • Fax: 614-245-4269
Mailing address:
  • Phone: 614-245-4263
  • Fax: 614-245-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35081746
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number239521
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-081746
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35-081746
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: