Provider Demographics
NPI:1356317150
Name:SMITH, GREGORY N (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4411 SW VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1020
Mailing Address - Country:US
Mailing Address - Phone:503-494-9992
Mailing Address - Fax:503-494-1967
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:503-626-4149
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD169520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011180781Medicaid
PAD93303Medicare UPIN
PAD93303Medicare UPIN