Provider Demographics
NPI:1558086124
Name:SMITH, STUART ALAN SR
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ALAN
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58147 COLUMBIA RIVER HWY STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6229
Mailing Address - Country:US
Mailing Address - Phone:503-396-5322
Mailing Address - Fax:
Practice Address - Street 1:58147 COLUMBIA RIVER HWY STE C
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6229
Practice Address - Country:US
Practice Address - Phone:503-396-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist