Individual
MICHAEL BENJAMIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2505 S DENVER ST, FAIRCHILD AFB, WA 99011-8650
(590) 247-5414
Mailing address
10012 S STANGLAND RD, MEDICAL LAKE, WA 99022-9409
(509) 299-6678
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004669
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1030141
NCCPA NUMBER
—
01
—
PA10004669
WA STATE MED LICENSE
WA
Enumeration date
05/25/2006
Last updated
07/08/2007
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