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General NPI Number Information
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NPI Number | 1740721810
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Entity Type | Individual
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Provider Name | KRISTINE ANNE SMITH MD
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Gender | Female
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/06/2022
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Provider Practice Location Address
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Address Line | 50 N MEDICAL DR OTOLARYNGOLOGY/ENT, CLINIC 9
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City | SALT LAKE CITY
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State | UT
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Zip | 84132
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Country | US
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Telephone | 801-587-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 BOWNESS RD NW
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City | CALGARY
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State | AB
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Zip | T2N3L1
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Country | CA
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Telephone | 587-228-3391
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 10222696-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 10222696-1205
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License Number State | UT
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