Individual
MATTHEW THOMAS SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
70 BOWER DRIVE, MEDFORD, OR 97501
(541) 734-3430
(541) 734-3638
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 734-3430
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA159571
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA159571
MEDICAL LICENSE
OR
Enumeration date
09/06/2012
Last updated
03/07/2023
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