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Individual

DOUGLAS LANE SMITH

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2131 E SOUTHERN AVENUE, TEMPE, AZ 85282
(480) 820-1200
(480) 820-5743
Mailing address
2131 E SOUTHERN AVENUE, TEMPE, AZ 85282
(480) 820-1200
(480) 820-5743

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
32793
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7449611
AETNA
05
865389
AZ
01
AZ0757140
BLUE CROSS
Enumeration date
02/22/2006
Last updated
07/08/2007
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