Most Relevant Information
Provider Data
| NPI Number: | 1003836701 |
| Provider Name: | ROOSEVELT SMITH PAC, ATR |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 9155 |
Most Important Dates
| Enumeration Date: | 07/19/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
62 E 3RD ST
SUITE 3
WINONA
MN
559873481
Practice Location Phone/Fax
| Phone: | 5074744770 |
| Fax: | 5074744774 |
Provider Mailing Location
62 E 3RD ST
SUITE 3
WINONA
MN
559873481
Provider Mailing Phone/Fax
| Phone: | 5074744770 |
| Fax: | 5074744774 |