Healthcare Provider Details

I. General information

NPI: 1003347782
Provider Name (Legal Business Name): ANNE SMAZAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S CHIPETA WAY STE 15
SALT LAKE CITY UT
84108-1231
US

IV. Provider business mailing address

295 S CHIPETA WAY STE 15
SALT LAKE CITY UT
84108-1231
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7400
  • Fax:
Mailing address:
  • Phone: 801-587-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036151907
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number81716-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number14240227-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: