Individual
MR. LARRY DERRELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
340 S WILLARD ST STE 101, COTTONWOOD, AZ 86326-4126
(928) 649-7960
(928) 634-1117
Mailing address
1200 N BEAVER ST, ATTN: PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1838
AZ
363A00000X
Physician Assistant
PA53072
CA
363AS0400X
Surgical Physician Assistant
PA53072
CA
Other
Enumeration date
01/28/2006
Last updated
06/19/2025
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