Healthcare Provider Details

I. General information

NPI: 1316994643
Provider Name (Legal Business Name): DOUGLAS A. SMYTH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NW 3RD ST
CORVALLIS OR
97330-6202
US

IV. Provider business mailing address

2538 VAN NESS ST
EUGENE OR
97403-1864
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-4905
  • Fax:
Mailing address:
  • Phone: 541-485-4905
  • Fax: 541-485-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1345
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: