Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD25573 | OR |
NPI | 1013924877 |
---|---|
Provider Name | Dr. Daryl Irving Smith |
First Address | Portland, OR 97208-2040 |
Second Address | Portland, OR 97209-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 16/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213517 | (05) | OR |
8428351 | (05) | WA |
E18321 | (02) | |
MD270OR | (05) | AK |
P00316340 | RR MEDICARE (01) | OR |