Healthcare Provider Details

I. General information

NPI: 1033303276
Provider Name (Legal Business Name): RICHARD SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

722 N TACOMA AVE
TACOMA WA
98403-2831
US

V. Phone/Fax

Practice location:
  • Phone: 180-828-5176
  • Fax:
Mailing address:
  • Phone: 808-285-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2018029428
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD-1040
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number61363351
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: