Individual
TANNER R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2620 N 140TH AVE STE 103, GOODYEAR, AZ 85395-2437
(623) 219-4777
(623) 219-4778
Mailing address
2620 N 140TH AVE STE 103, GOODYEAR, AZ 85395-2437
(623) 219-4777
(623) 219-4778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9328
AZ
Other
Enumeration date
07/20/2022
Last updated
12/14/2022
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