Provider Demographics
NPI:1427022359
Name:SMOOTS, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:SMOOTS
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036516174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA300130689OtherRAILROAD MEDICARE
WA8936615OtherCRIME VICTIMS
WA6304SMOtherREGENCE
2809969OtherAETNA
WA348938OtherL&I-RADIA REST OF WA
WA348939OtherL&I-RADIA KING COUNTY
WA348940OtherL&I-SWEDISH RADIA
WA1010051Medicaid
WA348941OtherL&I-EVERGREEN RADIA
WA8288318Medicaid
WA158392OtherL&I
WAP01623686Medicare PIN
WA8936615OtherCRIME VICTIMS
WAP01623666Medicare PIN
WA348941OtherL&I-EVERGREEN RADIA
WAP01623658Medicare PIN
WAAB27848Medicare PIN
WAH45356Medicare UPIN
WA8288318Medicaid
WAG8949067Medicare PIN