Provider Demographics
NPI:1558428672
Name:SMITH, DAVID WESLEY (LMP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 OVERHULSE RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3857
Mailing Address - Country:US
Mailing Address - Phone:360-866-6674
Mailing Address - Fax:
Practice Address - Street 1:3912 MARTIN WAY E.
Practice Address - Street 2:STE. B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5220
Practice Address - Country:US
Practice Address - Phone:360-459-9780
Practice Address - Fax:360-412-0581
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist