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General NPI Number Information
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NPI Number | 1760674071
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Entity Type | Organization
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Legal Business Name | GERIATRIC PSYCHIATRY ASSOCIATES NORTHWEST, P.C.
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 1231 NE MLK JR BLVD #611
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City | PORTLAND
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State | OR
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Zip | 97232-2073
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Country | US
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Telephone | 503-258-9714
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Fax | 503-254-4840
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Provider Business Mailing Address
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Address Line | 1231 NE MLK JR BLVD #611
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City | PORTLAND
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State | OR
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Zip | 97232-2073
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Country | US
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Telephone | 503-258-9714
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Fax | 503-254-4840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN R SMITH
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Credential | M.D.
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Telephone | 503-258-9714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | MD11891
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License Number State | OR
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