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General NPI Number Information
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NPI Number | 1922168194
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Entity Type | Individual
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Provider Name | LYNN ALDERSON SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 MENTOR AVE STE 2
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City | PAINESVILLE
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State | OH
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Zip | 44077-3225
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Country | US
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Telephone | 440-354-4312
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Fax | 440-357-7734
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Provider Business Mailing Address
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Address Line | 820 MENTOR AVE
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City | PAINESVILLE
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State | OH
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Zip | 44077-2518
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Country | US
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Telephone | 440-352-8744
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-02-9462-S
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License Number State | OH
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