Provider Demographics
NPI:1992803811
Name:SMITH, SCOTT ALLEN (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 E MISSION AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1061
Mailing Address - Country:US
Mailing Address - Phone:509-892-2480
Mailing Address - Fax:509-892-6708
Practice Address - Street 1:12509 E MISSION AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1061
Practice Address - Country:US
Practice Address - Phone:509-892-2480
Practice Address - Fax:509-892-6708
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002015207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology