Individual
DR. CONNIE JO SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11521 NE 128TH ST, SUITE 100, KIRKLAND, WA 98034-4317
(425) 899-6800
(425) 899-6808
Mailing address
PO BOX 34036, SEATTLE, WA 98124-1036
(425) 899-3292
(425) 899-3269
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD00023049
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035773
—
WA
01
—
107495
LABOR & INDUSTRIES
WA
01
—
P00156921
MEDICARE RAILROAD
WA
01
—
SM9838
BLUE SHIELD
WA
Enumeration date
11/22/2005
Last updated
06/18/2009
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