Healthcare Provider Details

I. General information

NPI: 1760019699
Provider Name (Legal Business Name): CAMERON G SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 S STATE ST
PROVO UT
84606-5056
US

IV. Provider business mailing address

589 S STATE ST
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-420-2000
  • Fax:
Mailing address:
  • Phone: 801-420-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12438118-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: