MEDICARE: DR. STANTON T 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	208600000X	Surgery Physician	154338	OR

General Provider Information

NPI Number	:	1518142967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANTON T SMITH MD

Provider Business Mailing Address
First Line	:	9329 GREENBRIAR DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-9412
Country	:	US
Telephone Number	:	910-409-8039
Fax Number	:	541-274-4666

Provider Business Practice Location Address
First Line	:	3000 BRYANT WILLIAMS DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1139
Country	:	US
Telephone Number	:	541-274-2345
Fax Number	:	541-274-4666

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	10/25/2013

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