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General NPI Number Information
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NPI Number | 1053633297
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Entity Type | Individual
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Provider Name | RYAN LEE SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 109 E HARRISON AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3238
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Country | US
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Telephone | 208-292-0281
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Fax | 844-807-3877
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Provider Business Mailing Address
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Address Line | PO BOX 1387
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City | HAYDEN
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State | ID
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Zip | 83835-1387
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Country | US
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Telephone | 208-415-0299
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Fax | 208-625-2070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-840
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA-840
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-840
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License Number State | ID
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