MEDICARE: DR. GREGORY N 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	207Q00000X	Family Medicine Physician	MD169520	OR

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	:	1356317150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY N SMITH MD

Provider Business Mailing Address
First Line	:	4411 SW VERMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-1020
Country	:	US
Telephone Number	:	503-494-9992
Fax Number	:	503-494-1967

Provider Business Practice Location Address
First Line	:	4855 SW WESTERN AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3460
Country	:	US
Telephone Number	:	503-813-2000
Fax Number	:	503-626-4149

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	08/18/2015

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