Individual
MICAH JEREMY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
750 W 800 N, OREM, UT 84057-3660
(801) 714-6570
(801) 714-6588
Mailing address
750 W 800 N, OREM, UT 84057-3660
(801) 714-6570
(801) 714-6588
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6396674-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63966741200001
BCBS
UT
01
—
P00434283
RR
—
Enumeration date
07/12/2006
Last updated
05/19/2008
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