Provider Demographics
NPI:1205832078
Name:SMITH, RAY F (MD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:F
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-454-1924
Mailing Address - Fax:360-454-1991
Practice Address - Street 1:2901 174TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4743
Practice Address - Country:US
Practice Address - Phone:360-454-1924
Practice Address - Fax:360-454-1991
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2022207Q00000X
WAMD60648525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73705829Medicaid
WA2063129Medicaid
TX125260307Medicaid
WA2063129Medicaid
TX125260307Medicaid
TX8J2639Medicare PIN