MEDICARE: MARK W. SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD00041077	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346288164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W. SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 1663
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-0031
Country	:	US
Telephone Number	:	509-619-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 W 51ST AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-4626
Country	:	US
Telephone Number	:	509-619-0562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	10/27/2014

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Directions to “ MARK W. SMITH MD” Practice Location

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