Donald Lee Smith
Individual provider Active NPI Driver · Yucca, AZ
NPI 1992830111 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992830111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 7275614 (OR)
- Practice address
- 12349 Frontage Rd
P.O.B.426
Yucca, AZ 86438-0426 - Phone
- (928) 208-0254
- Fax
- (928) 766-2363
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7275614 | OR | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 7275614 | OR | Yes |
Addresses
Primary practice location
12349 Frontage Rd
P.O.B.426
Yucca, AZ 86438-0426
Mailing address
12349 Frontage Rd
P.O.B.426
Yucca, AZ 86438-0426
Phone (928) 208-0254
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164739 | Other | AZ | AHCCCS PROVIDER # |
Other providers in Yucca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.