Healthcare Provider Details

I. General information

NPI: 1679617294
Provider Name (Legal Business Name): DR. JOEL REED SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOWER NAVY HILL ROAD COMMON WEALTH HEALTH CENTER
SAIPAN MP
96950
US

IV. Provider business mailing address

16520 ASHWORTH AVENUE NORTH
SHORELINE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 670-483-0161
  • Fax:
Mailing address:
  • Phone: 206-542-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31604
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0417
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: