Provider Demographics
NPI:1164519922
Name:SMITH, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
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 4749
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0227
Mailing Address - Country:US
Mailing Address - Phone:970-385-7977
Mailing Address - Fax:970-385-6727
Practice Address - Street 1:3011 EAST BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8301
Practice Address - Country:US
Practice Address - Phone:541-789-4673
Practice Address - Fax:541-789-5678
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38769207RX0202X
CO45611207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3339463Medicaid
TN3339462Medicaid
CO15559297Medicaid
AZ517659Medicaid
TN3339462Medicaid
AZ517659Medicaid
CO15559297Medicaid