Provider Demographics
NPI:1710107164
Name:SMITH, SCOTT MONTGOMERY (LMT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MONTGOMERY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 SW BARNES RD STE 280
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6673
Mailing Address - Country:US
Mailing Address - Phone:503-203-6855
Mailing Address - Fax:503-203-6922
Practice Address - Street 1:9450 SW BARNES RD STE 280
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6673
Practice Address - Country:US
Practice Address - Phone:503-203-6855
Practice Address - Fax:503-203-6922
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist