1558706846 NPI number — DOUGLAS C SMITH PHD

Table of content: DOUGLAS C SMITH PHD (NPI 1558706846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558706846 NPI number — DOUGLAS C SMITH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DOUGLAS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1558706846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 503010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97503-0813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-941-7792
Provider Business Mailing Address Fax Number:
503-416-4662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
542 WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-770-0303
Provider Business Practice Location Address Fax Number:
503-419-4662
Provider Enumeration Date:
05/01/2013

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: 103T00000X , with the licence number:  1980 , 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)





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