Provider Demographics
NPI:1023191095
Name:SMITH, FREDERICK B (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1001 FOURTH AVE PLAZA, STE 420
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98154
Practice Address - Country:US
Practice Address - Phone:206-320-3351
Practice Address - Fax:206-554-7787
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1970706Medicaid
WAAB22386Medicare PIN
WA1970706Medicaid
WAAB11333Medicare PIN
WAAB07874Medicare PIN