Individual
JUSTIN RYAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3442
(503) 494-5330
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3442
(503) 494-5330
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD216721
OR
207R00000X
Internal Medicine Physician
T-3673
MS
207RN0300X
Nephrology Physician
Primary
MD216721
OR
Other
Enumeration date
04/24/2018
Last updated
12/20/2023
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