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Individual
MR. LARRY DEAN SMITH
Active
Individual
MR. LARRY DEAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OP00001346
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264988
L&I
—
05
—
1078310
—
WA
01
—
G8886888
MEDICARE PTAN
WA
Enumeration date
04/06/2006
Last updated
08/25/2021
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