Individual
BENJAMIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2605 STATE ST, SALEM, OR 97310-5000
(503) 378-2453
Mailing address
OREGON STATE PENITENTIARY 2605, SALEM, OR 97310-5000
(503) 378-2453
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0101258753
VA
208D00000X
General Practice Physician
Primary
MD198549
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2014
Last updated
08/02/2023
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