Individual
SANDRA L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 NE MOTHER JOSEPH PL STE 420, VANCOUVER, WA 98664-3203
(360) 514-6161
(360) 514-6140
Mailing address
7261 MERCY RD, OMAHA, NE 68124-2311
(402) 398-6248
(402) 829-8513
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
29835
NE
208600000X
Surgery Physician
Primary
MD61154801
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000370031
BCBSM
MI
05
—
4337963
—
MI
05
—
4645836
—
MI
Enumeration date
03/16/2006
Last updated
08/10/2021
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