Healthcare Provider Details

I. General information

NPI: 1316682214
Provider Name (Legal Business Name): EVAN JAMES SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MARION BARRY AVE SE
WASHINGTON DC
20020-4708
US

IV. Provider business mailing address

901 W ST NW APT 712
WASHINGTON DC
20001-5686
US

V. Phone/Fax

Practice location:
  • Phone: 202-265-2400
  • Fax:
Mailing address:
  • Phone: 586-718-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO210012734
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: