Individual
MARK KENNETH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
904 NW YAMHILL ST, MCMINNVILLE, OR 97128-5061
(971) 241-3428
Mailing address
904 NW YAMHILL ST, MCMINNVILLE, OR 97128-5061
(971) 241-3428
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
BAP-E-10246999
OR
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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