Individual
MARK A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2869
AZ
363AM0700X
Medical Physician Assistant
Primary
16959
TX
363AM0700X
Medical Physician Assistant
686
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
949901
—
AZ
Enumeration date
11/14/2006
Last updated
01/09/2024
Update your record
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