Organization
DIRECT SURGICAL ASSIST PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY DALE SMITH PA-C (PRESIDENT)
(208) 989-0598
Entity
Organization
Contact information
Practice address
695 N ASPEN LAKES WAY, STAR, ID 83669-5674
(208) 989-0598
Mailing address
695 N ASPEN LAKES WAY, STAR, ID 83669-5674
(208) 989-0598
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/11/2011
Last updated
05/11/2011
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