Provider Demographics
NPI:1437846334
Name:SMITH, PETER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
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 1:1321 COLBY AVENUE
Mailing Address - Street 2:#B3-039
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-297-5234
Mailing Address - Fax:
Practice Address - Street 1:1321 COLBY AVENUE
Practice Address - Street 2:#B3-039
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-297-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-11-24
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2023-11-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program