Individual
DR. SCOTT ALAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Mailing address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
O-257
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010032253
BLUE SHIELD
ID
01
—
42283
BLUE CROSS
ID
05
—
806039800
—
ID
Enumeration date
09/08/2005
Last updated
11/19/2020
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