Individual
THEODORE C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2055 N MAIN ST, TOOELE, UT 84074-9819
(801) 698-4825
Mailing address
622 W LAFAYETTE ST, STANSBURY PARK, UT 84074-5571
(801) 698-4825
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28227009A
IN
163W00000X
Registered Nurse
7570542-3102
UT
163W00000X
Registered Nurse
9369122
FL
367500000X
Certified Registered Nurse Anesthetist
143224
MT
367500000X
Certified Registered Nurse Anesthetist
288227009A
IN
367500000X
Certified Registered Nurse Anesthetist
7570542-4406
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
7570542-8901
UT
Other
Enumeration date
01/16/2016
Last updated
05/17/2022
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