MEDICARE: ADAM 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	207P00000X	Emergency Medicine Physician	54498	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207P00000X	Emergency Medicine Physician	M-14140	ID

General Provider Information

NPI Number	:	1619363520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM SMITH MD

Provider Business Mailing Address
First Line	:	3080 E GENTRY WAY STE 210
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-3013
Country	:	US
Telephone Number	:	208-384-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 E GENTRY WAY STE 210
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-3013
Country	:	US
Telephone Number	:	208-384-9022
Fax Number	:

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

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	11/20/2018

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Directions to “ ADAM SMITH MD” Practice Location

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