Provider Demographics
NPI:1124067236
Name:SMITH, NORMAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 S 700 E
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1138
Mailing Address - Country:US
Mailing Address - Phone:801-410-0894
Mailing Address - Fax:801-483-3010
Practice Address - Street 1:77 S 700 E
Practice Address - Street 2:SUITE 220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1138
Practice Address - Country:US
Practice Address - Phone:801-410-0894
Practice Address - Fax:801-483-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT154745-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD99957Medicare UPIN
UT005582349Medicare PIN