Healthcare Provider Details

I. General information

NPI: 1184466732
Provider Name (Legal Business Name): SMITH ALEXANDER CONDON AAS-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N MONROE ST
SPOKANE WA
99205-2852
US

IV. Provider business mailing address

3812 N MONROE ST
SPOKANE WA
99205-2852
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-7078
  • Fax: 509-327-3404
Mailing address:
  • Phone: 509-327-7078
  • Fax: 509-327-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number61418899
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: