1649384298 NPI number — REX D SMITH D.P.M.

Table of content: REX D SMITH D.P.M. (NPI 1649384298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649384298 NPI number — REX D SMITH D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
REX
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649384298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 CHAMBERS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97402-3745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-342-3373
Provider Business Mailing Address Fax Number:
541-342-3374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 CHAMBERS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97402-3745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-342-3373
Provider Business Practice Location Address Fax Number:
541-342-3374
Provider Enumeration Date:
08/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  DP00142 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22733-0 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 831296000 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".