Healthcare Provider Details

I. General information

NPI: 1508941550
Provider Name (Legal Business Name): DEBORAH A. SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-7060
  • Fax: 360-493-7562
Mailing address:
  • Phone:
  • Fax: 425-258-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00026396
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: