Individual
MR. RANDAL LEE SMITH II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
10714 NE GLISAN ST, PORTLAND, OR 97220-4046
(503) 256-2453
Mailing address
10714 NE GLISAN ST, PORTLAND, OR 97220-4046
(503) 256-2453
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171MOOOOOX
—
OR
Enumeration date
06/11/2019
Last updated
06/11/2019
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