MEDICARE: GARY A SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD11631	OR
2	207Q00000X	Family Medicine Physician	MD00046149	WA
3	207P00000X	Emergency Medicine Physician	MD00046149	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00360925	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8948203	OTHER	WA	L & I CRIME VICTIMS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0238840	OTHER	WA	L & I
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144269960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY A SMITH MD

Provider Business Mailing Address
First Line	:	700 NE 87TH AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1913
Country	:	US
Telephone Number	:	360-397-1500
Fax Number	:	360-397-3128

Provider Business Practice Location Address
First Line	:	2005 W MAIN ST
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4311
Country	:	US
Telephone Number	:	360-397-4060
Fax Number	:	360-666-4772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/30/2008

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Directions to “ GARY A SMITH MD” Practice Location

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