Provider Demographics
NPI:1538120407
Name:SMITH, VANOY H (MD)
Entity Type:Individual
Prefix:
First Name:VANOY
Middle Name:H
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 1:1990 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9315
Mailing Address - Country:US
Mailing Address - Phone:360-856-4141
Mailing Address - Fax:360-856-4145
Practice Address - Street 1:1990 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9315
Practice Address - Country:US
Practice Address - Phone:360-856-4141
Practice Address - Fax:360-856-4145
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1818202Medicaid
WA1818202Medicaid