Individual
PRESTON S SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 468-5930
(208) 463-3044
Mailing address
215 E HAWAII AVE, NAMPA, ID 83686-6011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA464
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145449
BLUE SHIELD
ID
01
—
000010145450
BLUE SHIELD
ID
05
—
806749400
—
ID
01
—
DAGV3
BLUE CROSS
ID
01
—
P00160006
RAILROAD MEDICARE
ID
01
—
PAG001
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
11/01/2023
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