Provider Demographics
NPI:1992871503
Name:SMILEY, GREGORY ISRAEL (PA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ISRAEL
Last Name:SMILEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 HIGHWAY 62 # 101
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1024
Mailing Address - Country:US
Mailing Address - Phone:541-826-7410
Mailing Address - Fax:
Practice Address - Street 1:8336 HIGHWAY 62 # 101
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1024
Practice Address - Country:US
Practice Address - Phone:541-826-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16093363A00000X
PAPA16093363AM0700X
ORPA196853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical