Provider Demographics
NPI:1427077114
Name:SMITH, CHAD G (DPM)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:205 15TH AVE SW STE D
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7873
Mailing Address - Country:US
Mailing Address - Phone:253-845-0564
Mailing Address - Fax:253-770-8482
Practice Address - Street 1:205 15TH AVE SW STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7873
Practice Address - Country:US
Practice Address - Phone:253-845-0564
Practice Address - Fax:253-770-8482
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 60188334213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0275410Medicaid
WAPO 60188334OtherWASHINGTON STATE DEPT OF HEALTH LICENSE