Individual
DR. RILEY A SMYTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1789 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 499-2766
(920) 499-7080
Mailing address
1789 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 499-2766
(920) 499-7080
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301116329
MI
2085R0202X
Diagnostic Radiology Physician
Primary
62709
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301116329
MI LICCENSE
MI
01
—
62709-20
WI LICENSE
WI
01
—
ABR
AMERICAN BOARD OF RADIOLOGY/DIAGNOSTIC RADIOLOGY
—
Enumeration date
05/29/2008
Last updated
03/19/2020
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