Provider Demographics
NPI:1336183813
Name:SMITH, KENT J (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3738 S SPINNAKER BAY DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4769
Mailing Address - Country:US
Mailing Address - Phone:801-505-3095
Mailing Address - Fax:855-763-4499
Practice Address - Street 1:1543 W 12600 S STE 102
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7176
Practice Address - Country:US
Practice Address - Phone:801-563-5121
Practice Address - Fax:801-566-3926
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5997207RG0100X
UT8759217-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002770000Medicaid
IDP00659685OtherMCRR
ID11255832Medicare PIN
IDP00659685OtherMCRR