Provider Demographics
NPI:1063404218
Name:SMETANA, LORI S (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:SMETANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:SAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2714
Mailing Address - Country:US
Mailing Address - Phone:509-455-8866
Mailing Address - Fax:509-838-3411
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE #301
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2714
Practice Address - Country:US
Practice Address - Phone:509-455-8866
Practice Address - Fax:509-838-3411
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033714174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASM3651OtherASURIS
WA8192668Medicaid
WAA007OtherTRIWEST
WAAB16967Medicare ID - Type Unspecified
WA8192668Medicaid