Provider Demographics
NPI:1194938191
Name:WAYNE E SMITH MD PC
Entity type:Organization
Organization Name:WAYNE E SMITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-479-6200
Mailing Address - Street 1:5333 S ADAMS AVE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-479-6200
Mailing Address - Fax:801-479-1698
Practice Address - Street 1:5333 S ADAMS AVE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-479-6200
Practice Address - Fax:801-479-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1592731205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164404497OtherINDIVIDUAL NPI#
UTD20122Medicare UPIN