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General NPI Number Information
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NPI Number | 1619929783
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SKIN AND CANCER LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 383 S 300 E
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City | ST GEORGE
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State | UT
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Zip | 84770-3620
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Country | US
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Telephone | 435-628-2826
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Fax | 435-628-2839
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Provider Business Mailing Address
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Address Line | 383 S 300 E
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City | ST GEORGE
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State | UT
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Zip | 84770-3620
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Country | US
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Telephone | 435-628-2826
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Fax | 435-628-2839
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Authorized Official
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Title or Position | PARTNER AND OWNER
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Name | W BRET SMITH
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Credential | MD
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Telephone | 435-628-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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