Provider Demographics
NPI:1477621597
Name:SMITH, DONALD EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:300 E DIMOND BLVD
Mailing Address - Street 2:#12
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1908
Mailing Address - Country:US
Mailing Address - Phone:907-341-7757
Mailing Address - Fax:907-341-7760
Practice Address - Street 1:1700 E PARKS HWY
Practice Address - Street 2:#200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7352
Practice Address - Country:US
Practice Address - Phone:907-373-6055
Practice Address - Fax:907-373-6077
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO4243Medicare UPIN