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Individual

MR. EVAN ERNEST SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
AAS, LMT

Contact information

Practice address
1314 NE 8TH ST, BEND, OR 97701-4469
(541) 788-0595
Mailing address
1314 NE 8TH ST, BEND, OR 97701-4469
(541) 788-0595

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10819
OR

Other

Enumeration date
05/06/2010
Last updated
05/06/2010
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