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General NPI Number Information
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NPI Number | 1114011905
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Entity Type | Individual
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Provider Name | MATTHEW A. SMITH CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 2055 N MAIN ST.
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City | TOOELE
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State | UT
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Zip | 84074
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Country | US
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Telephone | 435-843-3600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | BOUNTIFUL
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State | UT
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Zip | 84011-0268
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Country | US
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Telephone | 801-296-2113
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Fax | 801-296-1715
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 722182
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License Number State | TX
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