MEDICARE: DR. LANE FIELDING 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	208200000X	Plastic Surgery Physician	274582-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	880512075	OTHER	UT	TAX ID #

General Provider Information

NPI Number	:	1982779526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANE FIELDING SMITH M.D.

Provider Business Mailing Address
First Line	:	8871 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5865
Country	:	US
Telephone Number	:	702-838-2455
Fax Number	:	702-838-7055

Provider Business Practice Location Address
First Line	:	8871 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5865
Country	:	US
Telephone Number	:	702-838-2455
Fax Number	:	702-838-7055

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/15/2013

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