Individual
MR. EDWARD GREGORY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-A
Contact information
Practice address
921 S 8TH AVE STOP 8116, POCATELLO, ID 83209-0002
(208) 282-3495
(208) 282-4571
Mailing address
1651 W SUNDANCE RD, POCATELLO, ID 83204-7418
(208) 233-3435
(208) 232-0379
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
HA-1052
ID
Other
Enumeration date
10/10/2008
Last updated
10/10/2008
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