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General NPI Number Information
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NPI Number | 1366612343
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Entity Type | Individual
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Provider Name | STEPHEN RUSSELL SMITH PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 2615 E HIGH STREET SPRINGFIELD EMERGENCY PHYSICIANS INC.
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City | SPRINGFIELD
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State | OH
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Zip | 45501
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Country | US
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Telephone | 937-328-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 E HIGH SPRINGFIELD EMERGENCY PHYSICIANS INC.
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City | SPRINGFIELD
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State | OH
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Zip | 45501
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Country | US
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Telephone | 937-328-9301
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Fax |
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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 . 002725
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License Number State | OH
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