MEDICARE: DR. DOUGLAS ROLAND SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	56913841205	UT
2	207Q00000X	Family Medicine Physician	56913841205	UT

General Provider Information

NPI Number	:	1174681928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ROLAND SMITH M.D.

Provider Business Mailing Address
First Line	:	4417 S DORIS WAY
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84124-3525
Country	:	US
Telephone Number	:	801-682-6817
Fax Number	:

Provider Business Practice Location Address
First Line	:	4544 S HOLLADAY BLVD
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4404
Country	:	US
Telephone Number	:	801-682-6817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/25/2022

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