Provider Demographics
NPI:1922382282
Name:SMITH, RYAN ATKINSON (MED)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ATKINSON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-517-8654
Mailing Address - Fax:541-343-5875
Practice Address - Street 1:1193 PEARL STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-517-8654
Practice Address - Fax:541-343-5875
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist