Basic Information
| Provider Information | |||||||||
| NPI: | 1114965373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMOLARZ | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12390 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008015390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407748881 | ||||||||
| FaxNumber: | 3407769807 | ||||||||
| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS STE 308 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008023132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407748881 | ||||||||
| FaxNumber: | 3407769807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 200496 | LA | N | Allopathic & Osteopathic Physicians | Surgery | 174400000X | 1634 | VI | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1072451 | 05 | LA | MEDICAID |