# SMITH TRYON FAMILY HEALTH INC D.B.A. BLUE WATER MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336104462
- **Authorized official:** DR. ELIZABETH ANNE SMITH TRYON MD (PRESIDENT)
- **Authorized official phone:** (928) 453-6963

## Contact information

- **Practice address:** 1801 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5664
- **Practice address phone:** (928) 453-6963
- **Practice address fax:** (928) 453-7015
- **Mailing address:** 1990 MCCULLOCH BLVD N, SUITE D, BOX 379D, LAKE HAVASU CITY, AZ 86403-5749
- **Mailing address phone:** (928) 453-6963
- **Mailing address fax:** (928) 453-7015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35026 | AZ | Yes |
| 207R00000X | Internal Medicine Physician | 35026 | AZ | — |
| 208D00000X | General Practice Physician | 2768 | AZ | — |

## Other

- **Enumeration date:** 04/20/2006
- **Last updated:** 09/27/2010