Provider Demographics
NPI:1285645945
Name:SMOOTS, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SMOOTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1608 S J ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:253-274-7993
Practice Address - Street 1:1608 S J ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7503
Practice Address - Fax:253-274-7993
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0126522OtherSTATE L&I
WA1030923Medicaid
WA0301188OtherSTATE L&I
WA110184900OtherMEDICARE RAILROAD
WAAB08487OtherSTATE CRIME VICTTIMS
WAAB08487OtherSTATE CRIME VICTTIMS
WA0126522OtherSTATE L&I
001-048-818Medicare ID - Type Unspecified