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Individual

TIFFANY SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3860 CRATER LAKE AVE STE A, MEDFORD, OR 97504-9741
(541) 858-1003
(541) 857-4499
Mailing address
3860 CRATER LAKE AVE STE A, MEDFORD, OR 97504-9741
(541) 858-1003
(541) 857-4499

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA189566
OR
363A00000X
Physician Assistant
PA2016-0100
NM

Other

Enumeration date
11/22/2016
Last updated
02/08/2019
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