Healthcare Provider Details

I. General information

NPI: 1134357361
Provider Name (Legal Business Name): COLIN SEALE SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 13TH STREET EVERETT, WA 98201
EVERETT WA
98201
US

IV. Provider business mailing address

5947 44TH AVE SW
SEATTLE WA
98136-1416
US

V. Phone/Fax

Practice location:
  • Phone: 425-621-2000
  • Fax:
Mailing address:
  • Phone: 954-681-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP60304409
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: