Individual
MR. LARRY DEAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
617 BENTON ST, OMAK, WA 98841
(509) 422-7416
(509) 634-2945
Mailing address
PO BOX 71, NESPELEM, WA 99155-0071
(509) 634-2995
(509) 634-2945
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OP00001346
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264988
L&I
—
05
—
1078310
—
WA
01
—
G8886888
MEDICARE PTAN
WA
Enumeration date
04/06/2006
Last updated
08/25/2021
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