Individual
MR. DONALD LEE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12349 FRONTAGE RD, P.O.B.426, YUCCA, AZ 86438-0426
(928) 208-0254
(928) 766-2363
Mailing address
12349 FRONTAGE RD, P.O.B.426, YUCCA, AZ 86438-0426
(928) 208-0254
(928) 766-2363
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
7275614
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164739
AHCCCS PROVIDER #
AZ
Enumeration date
02/21/2007
Last updated
07/08/2007
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