MEDICARE: DR. DEBORAH RENEE 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	00036462	WA

General Provider Information

NPI Number	:	1588303838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH RENEE SMITH MD

Provider Business Mailing Address
First Line	:	1400 LAKE WASHINGTON BLVD N APT C405
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-6410
Country	:	US
Telephone Number	:	206-707-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 LAKE WASHINGTON BLVD N APT C405
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-6410
Country	:	US
Telephone Number	:	206-707-3651
Fax Number	:

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

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	06/03/2022

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