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General NPI Number Information
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NPI Number | 1306823802
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Entity Type | Individual
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Provider Name | PHILLIP T SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 1 N BROOKWOOD AVE
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City | HAMILTON
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State | OH
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Zip | 45013
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Country | US
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Telephone | 513-805-4499
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Fax | 513-805-4499
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Provider Business Mailing Address
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Address Line | 1 N BROOKWOOD AVE
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City | HAMILTON
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State | OH
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Zip | 45013
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Country | US
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Telephone | 513-805-4499
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Fax | 513-805-4498
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003797RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA074
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License Number State | MS
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