Individual
DEAN TY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
79 N MAIN ST, DOWNEY, ID 83234-4703
(208) 897-5600
(208) 897-5603
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
(208) 232-7869
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-136
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002812000
—
ID
Enumeration date
07/07/2006
Last updated
03/06/2024
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