Wallace Austin Smith (NPI# 1376800532, PAC ID# 1557654746) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1376800532 |
| PAC ID by PECOS | 1557654746 |
| Professional Enrollment ID | I20160726001413 |
| Full Name | Wallace Austin Smith |
| Organization Legal Name | SOUTHWEST SKIN AND CANCER LLC |
| Address |
340 Falcon Ridge Pkwy Suite 203 Mesquite NV 89027-8851 |
| Phone Number | 4356282846 |
| Gender | M |
| Medical School | MEDICAL COLLEGE OF WISCONSIN |
| Graduation Year | 2012 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 4587675004 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460021 | DIXIE REGIONAL MEDICAL CENTER |
| 460057 | PARK CITY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 340 Falcon Ridge Pkwy, Suite 203, Mesquite, NV 89027-8851 | 4356282846 | SOUTHWEST SKIN AND CANCER LLC |
| 383 S 300, St George, UT 84770-3620 | 4356282826 | SOUTHWEST SKIN AND CANCER LLC |
| Organization Legal Name | SOUTHWEST SKIN AND CANCER LLC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Wallace Bret Smith | Dermatology | Southwest Skin and Cancer LLC | 383 S 300, St George, UT 84770-3620 |
| Timothy John Nowatzke | Physician Assistant | Southwest Skin and Cancer LLC | 383 S 300, St George, UT 84770-3620 |
| Greg R Jacobsen | Dermatology | Southwest Skin and Cancer LLC | 383 S 300, St George, UT 84770-3620 |
| Scott Condie | Physician Assistant | Southwest Skin and Cancer LLC | 383 S 300, St George, UT 84770-3620 |
| Street Address |
340 FALCON RIDGE PKWY SUITE 203 |
| City | MESQUITE |
| State | NV |
| Zip | 89027-8851 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kyle S Ozaki | Physical Therapy | Marchant Physical Therapy and Wellness Inc | 340 Falcon Ridge Pkwy, Suite 500, Mesquite, NV 89027-8850 |
| Jaldeep H Daulat | Dermatology | J H Daulat Do PC | 340 Falcon Ridge Pkwy, Suite 404, Mesquite, NV 89027-8851 |
| John D Giles | Physical Therapy | Marchant Physical Therapy and Wellness Inc | 340 Falcon Ridge Pkwy, Suite 500, Mesquite, NV 89027-8850 |
| Christopher Larrabee | Physical Therapy | Marchant Physical Therapy and Wellness Inc | 340 Falcon Ridge Pkwy, Suite 500, Mesquite, NV 89027-8850 |
| Trenton Laird | Physical Therapy | Marchant Physical Therapy and Wellness Inc | 340 Falcon Ridge Pkwy, Suite 500, Mesquite, NV 89027-8850 |
| Ryan Whitaker | Qualified Audiologist | Dixie Hearing and Balance Center | 340 Falcon Ridge Pkwy, Bldg 500, Mesquite, NV 89027-8850 |
| Darren O Marchant | Physical Therapy | Marchant Physical Therapy and Wellness Inc | 340 Falcon Ridge Pkwy, Suite 500, Mesquite, NV 89027-8850 |
| Michael L Roos | Physician Assistant | J H Daulat Do PC | 340 Falcon Ridge Pkwy, Suite 404, Mesquite, NV 89027-8851 |
| Ryan Kent Workman | Interventional Pain Management | Desert Pain Specialists LLC | 340 Falcon Ridge Pkwy, Suite 603, Mesquite, NV 89027-8852 |
| Aaron W Mccook | Physician Assistant | Daniel Taheri Md PC | 340 Falcon Ridge Pkwy, Suite 202, Mesquite, NV 89027-8851 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kurt Colter Sawyer | Nurse Practitioner | Alfaro Ltd | 450 Hillside Dr, Suite 104, Mesquite, NV 89027-3120 |
| April Christine Peterson | Nurse Practitioner | Alfaro Ltd | 450 Hillside Dr, Suite 104, Mesquite, NV 89027-3120 |
| Janel I Hillstrom | Nurse Practitioner | Alfaro Ltd | 450 Hillside Dr, Suite 104, Mesquite, NV 89027-3120 |
| Ann Doty | Nurse Practitioner | Alfaro Ltd | 450 Hillside Dr, Suite 104, Mesquite, NV 89027-3120 |
| Robert D Hillstead | Optometry | 840 Pinnacle Ct, Suite 102, Mesquite, NV 89027-3304 | |
| Leigh S Roessner | Chiropractic | 840 Pinnacle Ct, Suite 5a, Mesquite, NV 89027-3322 | |
| James A Davis | Chiropractic | 12 W Mesquite Blvd, Suite 104, Mesquite, NV 89027-4774 | |
| Mark T Hunt | Optometry | Sharon Richens Md Eye Physician and Surgeon PC | 330 N Sandhill Blvd, Suite A, Mesquite, NV 89027-4779 |
| Joshua J Terry | Optometry | Sharon Richens Md Eye Physician and Surgeon PC | 330 N Sandhill Blvd, Suite A, Mesquite, NV 89027-4779 |
| Scott K Brotherson | Optometry | 61 N Willow St, Suite 2, Mesquite, NV 89027-4786 | |
| Find all physicians in zip 89027 | |||
| City | MESQUITE |
| Zip Code | 89027 |
| Specialty | DERMATOLOGY |
| City + Specialty | MESQUITE + DERMATOLOGY |
Please comment or provide details below to improve the information on Wallace Austin Smith.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.