Healthcare Provider Details

I. General information

NPI: 1164468955
Provider Name (Legal Business Name): ANDREW SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7390 S CREEK RD STE 201
SANDY UT
84093-6123
US

IV. Provider business mailing address

6095 S FASHION BLVD STE 100
MURRAY UT
84107-7377
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-8700
  • Fax: 801-263-8693
Mailing address:
  • Phone: 801-263-8700
  • Fax: 801-263-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number8771272-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35084855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: