Basic Information
| Provider Information | |||||||||
| NPI: | 1033143177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WADE T. SMITH, DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1954 FORT UNION BLVD | ||||||||
| Address2: | 107 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841216800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019939527 | ||||||||
| FaxNumber: | 8017335872 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 W 9000 S | ||||||||
| Address2: | |||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840888812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019939527 | ||||||||
| FaxNumber: | 8017335872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | WADE | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8019939527 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.