Provider Demographics
NPI:1366409740
Name:SMITH, HERBERT MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H. MATT
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:TRIOS CARE CENTER AT DEBIT
Mailing Address - Street 2:320 W. 10TH AVENUE SUITE 202
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-221-5520
Mailing Address - Fax:509-585-4161
Practice Address - Street 1:401 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3926
Practice Address - Country:US
Practice Address - Phone:509-585-5500
Practice Address - Fax:509-585-4161
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1266OtherGROUP HEALTH COOP ID
WA836293000OtherREGENCE BCBS OREGON
WA4531768OtherAETNA PROVIDER ID
WA0161428OtherLABOR & INDUSTRIES ID
WA0801186563OtherRAILROAD MEDICARE ID
WA348362800OtherUS DEPT OF LABOR
WA2089786OtherFIRST HEALTH ID
WA00358OtherDEPT OF HEALTH EIP ID
WA1658905Medicaid
WA8937316OtherCRIME VICTIMS ID
WA9250SMOtherREGENCE ASURIS ID