MEDICARE: DR. PAUL E 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	208600000X	Surgery Physician	M8178	ID

General Provider Information

NPI Number	:	1396740593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL E SMITH MD

Provider Business Mailing Address
First Line	:	4042 EUREKA RIDGE RD
Second Line	:
City	:	OROFINO
State	:	ID
Zip	:	83544-9547
Country	:	US
Telephone Number	:	208-476-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	4042 EUREKA RIDGE RD
Second Line	:
City	:	OROFINO
State	:	ID
Zip	:	83544-9547
Country	:	US
Telephone Number	:	208-476-7630
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/28/2007

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Directions to “ DR. PAUL E SMITH MD” Practice Location

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