Provider Demographics
NPI:1225104854
Name:SMUCKER, RAY E (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:E
Last Name:SMUCKER
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:110 CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-8134
Practice Address - Country:US
Practice Address - Phone:503-829-2273
Practice Address - Fax:503-829-2291
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01238404OtherRR MEDICARE (PH&S)
OR221960Medicaid
OR221960Medicaid
ORP01238404OtherRR MEDICARE (PH&S)