Provider Demographics
NPI:1821099672
Name:SMITH, BRUCE CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CAMERON
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 1:2811 S 102ND ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1870
Mailing Address - Country:US
Mailing Address - Phone:206-320-4000
Mailing Address - Fax:
Practice Address - Street 1:2811 S 102ND ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-1870
Practice Address - Country:US
Practice Address - Phone:206-320-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23254207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7093206Medicaid
WAGAB08681Medicare PIN
WAD33782Medicare UPIN