Individual
RUSSEL DONNAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3567 NE TILLAMOOK ST, PORTLAND, OR 97212-5158
(773) 810-9072
Mailing address
3567 NE TILLAMOOK ST, PORTLAND, OR 97212-5158
(773) 810-9072
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2005012199
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00861014
—
NY
Enumeration date
12/15/2005
Last updated
03/23/2015
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