Provider Demographics
NPI:1538375415
Name:SMITH, DARIN THOMAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:DARIN
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1373 CASSITY DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4107
Mailing Address - Country:US
Mailing Address - Phone:435-843-9995
Mailing Address - Fax:435-882-0186
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1650
Practice Address - Country:US
Practice Address - Phone:435-882-8610
Practice Address - Fax:435-882-0186
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2775881206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant