MEDICARE: ELIZABETH R SMITH MD

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	208000000X	Pediatrics Physician	5211287-1205	UT

General Provider Information

NPI Number	:	1336239961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH R SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 413021
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3021
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3690 S MAIN ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-4423
Country	:	US
Telephone Number	:	801-464-8929
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/17/2021

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