Provider Demographics
NPI:1588303838
Name:SMITH, DEBORAH RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LAKE WASHINGTON BLVD N APT C405
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-6410
Mailing Address - Country:US
Mailing Address - Phone:206-707-3651
Mailing Address - Fax:
Practice Address - Street 1:1400 LAKE WASHINGTON BLVD N APT C405
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-6410
Practice Address - Country:US
Practice Address - Phone:206-707-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000364622083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine