Provider Demographics
NPI:1063751097
Name:SMITH, ROBERT KEITH (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEITH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:KEITH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7612 88TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4910
Mailing Address - Country:US
Mailing Address - Phone:253-582-2331
Mailing Address - Fax:
Practice Address - Street 1:7612 88TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4910
Practice Address - Country:US
Practice Address - Phone:253-582-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00011444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist