Provider Demographics
NPI:1740299239
Name:SMITH, RONALD P (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:P
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:877-747-2455
Mailing Address - Fax:
Practice Address - Street 1:4525 3RD AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-754-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8903088Medicare UPIN