Mark Randall Smith, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP2907 Issued in MN

Practice address

904 Hwy 15 South Frontage Rd.
Suite H
Hutchinson, MN 55350

Phone

(320) 587-2939

Fax

(320) 864-1927

NPI assigned

Sep 7, 2005

Last updated

Oct 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225324800000",
    "number": "1790779775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 HWY 15 SOUTH FRONTAGE RD.",
            "address_2": "SUITE H",
            "city": "HUTCHINSON",
            "state": "MN",
            "postal_code": "55350",
            "telephone_number": "320-587-2939",
            "fax_number": "320-864-1927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 HWY 15 SOUTH FRONTAGE RD.",
            "address_2": "SUITE H",
            "city": "HUTCHINSON",
            "state": "MN",
            "postal_code": "55350",
            "telephone_number": "320-587-2939",
            "fax_number": "320-864-1927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "RANDALL",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2008-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugenio S. Siruno, M.D.
• Theresa Marie Skrove, PT
• Amy Skusa
• Andrea Sloane, LPCC
• Jalayna Ashley Smith, M.D.
• Tess Smith, RN
• Tim Allen Smith, M.D.
• Steven Paul Somerville, D.C.
• Steven Francis Sonnek, M.D.
• Scott A. Staples, M.D.

• Psychologist in Hutchinson, MN
• Providers in Hutchinson, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.