Individual
MEGAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
375 PARK AVE STE 5, COOS BAY, OR 97420
(541) 267-7543
(503) 362-8435
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA190162
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500757502
—
OR
Enumeration date
09/14/2016
Last updated
04/11/2019
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