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NPI Code Detail

MEDICARE: KECIA RAE SMETTE DO

MEDICARE: KECIA RAE SMETTE DO
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
1207Q00000XFamily Medicine Physician4730AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912128067
Entity Type Code : Individual
Provider Name (Legal Business Name) : KECIA RAE SMETTE DO
Provider Business Mailing Address
First Line : PO BOX 60123
Second Line : NO APPOINTMENT MD
City : PHOENIX
State : AZ
Zip : 85082-0123
Country : US
Telephone Number : 602-992-7700
Fax Number : 602-971-2572
Provider Business Practice Location Address
First Line : 6677 W THUNDERBIRD RD STE A124
Second Line : NO APPOINTMENT MD
City : GLENDALE
State : AZ
Zip : 85306-3710
Country : US
Telephone Number : 623-773-2266
Fax Number : 623-773-2267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 04/12/2011

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