Provider Demographics
NPI:1326139080
Name:SMITH, SIDNEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1305 FOWLER STREET
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4715
Mailing Address - Country:US
Mailing Address - Phone:509-783-2004
Mailing Address - Fax:509-783-1949
Practice Address - Street 1:1295 FOWLER ST # 1B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4723
Practice Address - Country:US
Practice Address - Phone:509-783-2004
Practice Address - Fax:509-783-1949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046007207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology