Individual
DR. SAM P SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4915 EAST BASELINE ROAD, SUITE 102, GILBERT, AZ 85234-2966
(480) 646-8660
(480) 646-8665
Mailing address
4915 EAST BASELINE ROAD, SUITE 102, GILBERT, AZ 85234-2966
(480) 646-8660
(480) 646-8665
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4237
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11458639
CAQH
AZ
05
—
117012
—
AZ
Enumeration date
07/17/2006
Last updated
08/16/2013
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