Provider Demographics
NPI:1972561447
Name:SMITH, DOUGLAS C (PSYCHIATRIST)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYCHIATRIST
Other - Prefix:
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Mailing Address - Street 1:415 6TH ST
Mailing Address - Street 2:SUITE G16
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1020
Mailing Address - Country:US
Mailing Address - Phone:907-789-2855
Mailing Address - Fax:907-789-2862
Practice Address - Street 1:415 6TH STREET
Practice Address - Street 2:SUITE G16
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-789-2855
Practice Address - Fax:907-789-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK34222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD34221Medicaid
F74802Medicare UPIN
AKK160697Medicare PIN