Individual
MR. KIRK MACDONALD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, FNP
Contact information
Practice address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(541) 773-3863
(541) 618-4413
Mailing address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(541) 773-3863
(541) 618-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200150032
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227698
—
OR
Enumeration date
06/30/2005
Last updated
09/09/2011
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