Individual
DR. ROGER A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19196
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292300
—
AZ
01
—
39 81220
EVERCARE GRP
AZ
01
—
453051001
GROUP HEALTH GRP
AZ
01
—
86 0373636
HUMANA GROUP
AZ
01
—
AW1436
HEALTHNET GRP
AZ
01
—
AZ0728670
BLUE CROSS BLUE SHIELD GR
AZ
Enumeration date
11/10/2005
Last updated
05/01/2019
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