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General NPI Number Information
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NPI Number | 1336183813
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Entity Type | Individual
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Provider Name | KENT J SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1543 W 12600 S STE 102
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City | RIVERTON
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State | UT
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Zip | 84065-7176
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Country | US
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Telephone | 801-563-5121
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Fax | 801-566-3926
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Provider Business Mailing Address
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Address Line | 3738 S SPINNAKER BAY DR
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-4769
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Country | US
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Telephone | 801-505-3095
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Fax | 855-763-4499
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | M5997
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 8759217-1205
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License Number State | UT
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