Individual
DR. EDWARD LAWRENCE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1411 N TAYLOR DR, SHEBOYGAN, WI 53081-3043
(616) 735-3257
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 457-2100
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
5101016859
MI
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
55826-21
WI
Other
Enumeration date
05/13/2007
Last updated
09/15/2016
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