Basic Information
| Provider Information | |||||||||
| NPI: | 1013949940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BARRIE | ||||||||
| MiddleName: | VON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 955 E BLACK CANYON HWY | ||||||||
| Address2: | |||||||||
| City: | EMMETT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836179501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083656660 | ||||||||
| FaxNumber: | 2083651003 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 N WARDWELL AVE | ||||||||
| Address2: | |||||||||
| City: | EMMETT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836173040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083656311 | ||||||||
| FaxNumber: | 2083651003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | M-3278 | ID | Y | Other Service Providers | Specialist |
No ID Information.