| Doctor Name: | ROOSEVELT SMITH |
| NPI Number: | 1003836701 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC, ATR |
| License Number: | 500023 |
| Business Practice Address: | 62 E 3rd St Suite 3 Winona, MN - 559873481 |
| Business Phone Number: | 5074744770 |
| Business Fax Number: | 5074744774 |
| Mailing Address: | 62 E 3rd St, Suite 3 WINONA |
| State: | MN |
| Postal Code: | 559873481 |
| Phone Number: | 5074744770 |
| Fax Number: | 5074744774 |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 500023 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |