Individual
KENNETH R SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6040 N 43RD AVE STE 1, GLENDALE, AZ 85301-5481
(623) 931-2221
(623) 934-2849
Mailing address
3815 E BELL RD STE 4500, PHOENIX, AZ 85032-2171
(602) 633-3848
(602) 633-3841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1718
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259566
—
AZ
01
—
AZ0067790
BCBS
AZ
Enumeration date
10/05/2006
Last updated
07/31/2024
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