Provider Demographics
NPI:1386766566
Name:SMITH, LANE FARR (MD)
Entity type:Individual
Prefix:DR
First Name:LANE
Middle Name:FARR
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 BRIDGER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1836
Mailing Address - Country:US
Mailing Address - Phone:801-942-1543
Mailing Address - Fax:
Practice Address - Street 1:10150 CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4103
Practice Address - Country:US
Practice Address - Phone:801-256-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150771-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry