Individual
CHARLES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
107 E OAK AVE, FLAGSTAFF, AZ 86001-1818
(928) 913-8800
(928) 913-8801
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28946
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
719536
—
AZ
Enumeration date
02/03/2006
Last updated
12/06/2024
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