Healthcare Provider Details

I. General information

NPI: 1407968464
Provider Name (Legal Business Name): KIT D SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 - 8TH AVENUE ASC
SALT LAKE CITY UT
84103
US

IV. Provider business mailing address

3340 NORTH CENTER ST #800
LEHI UT
84043-7406
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-3200
  • Fax: 801-733-5618
Mailing address:
  • Phone: 801-990-1910
  • Fax: 801-990-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number76-160179-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: