Basic Information
| Provider Information | |||||||||
| NPI: | 1174067698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROSMITH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1377 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507041377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192333400 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 KIMBALL AVE | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192342649 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | LOREN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3192333044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD-43364 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.