Provider Demographics
NPI:1376767608
Name:SMITH, DANIEL NOAM (ND)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NOAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1105
Mailing Address - Country:US
Mailing Address - Phone:541-882-5602
Mailing Address - Fax:541-882-5897
Practice Address - Street 1:2664 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1105
Practice Address - Country:US
Practice Address - Phone:541-882-5602
Practice Address - Fax:541-882-5897
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1322175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath