Provider Demographics
NPI:1952358954
Name:SMITH, STEPHEN LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LLOYD
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 1:1200 N 14TH AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4182
Mailing Address - Country:US
Mailing Address - Phone:509-943-2101
Mailing Address - Fax:509-547-5983
Practice Address - Street 1:1200 N 14TH AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4182
Practice Address - Country:US
Practice Address - Phone:509-943-2101
Practice Address - Fax:509-547-5983
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019257207Q00000X
WAM100019537207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1786607Medicaid
WA40535OtherLABOR AND INDUSTRIES
WA1786607Medicaid
WA40535OtherLABOR AND INDUSTRIES