Provider Demographics
NPI:1437333945
Name:SMITH, CORDELL BECKER (DPM)
Entity Type:Individual
Prefix:DR
First Name:CORDELL
Middle Name:BECKER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1597
Mailing Address - Country:US
Mailing Address - Phone:541-673-7322
Mailing Address - Fax:541-673-3615
Practice Address - Street 1:2300 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1597
Practice Address - Country:US
Practice Address - Phone:541-673-7322
Practice Address - Fax:541-673-3615
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL 1713213ES0103X
ORDP151009213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00941330Medicare PIN
ORR154075Medicare PIN