Provider Demographics
NPI:1437218211
Name:SMITH, FLOYD D (MD)
Entity Type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:D
Last Name:SMITH
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:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0868
Mailing Address - Country:US
Mailing Address - Phone:360-330-2023
Mailing Address - Fax:360-623-1585
Practice Address - Street 1:1611 KRESKY AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8982
Practice Address - Country:US
Practice Address - Phone:360-330-2023
Practice Address - Fax:360-623-1585
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1940006Medicaid
WA18470OtherLABOR & INDUSTRIES
WA1940006Medicaid
WAG000917107Medicare PIN