Provider Demographics
NPI:1427097971
Name:SMITH, DOUGLAS E (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:EARL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:MADIGAN HEALTHCARE SYSTEM
Mailing Address - Street 2:9040 JACKSON AVENUE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-2366
Mailing Address - Fax:253-968-5900
Practice Address - Street 1:MADIGAN HEALTHCARE SYSTEM
Practice Address - Street 2:9040 JACKSON AVENUE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-2366
Practice Address - Fax:253-968-5900
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3522207T00000X
FLME 109503207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002755500Medicaid
1121084Medicare PIN
A76853Medicare UPIN