Healthcare Provider Details

I. General information

NPI: 1700709904
Provider Name (Legal Business Name): JOHN ANDREW SMIALEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAIN AVE
TILLAMOOK OR
97141-3816
US

IV. Provider business mailing address

906 MAIN AVE
TILLAMOOK OR
97141-3816
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-8201
  • Fax: 503-815-1870
Mailing address:
  • Phone: 503-842-8201
  • Fax: 503-815-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: