Provider Demographics
NPI:1730170747
Name:SMICK, LARRY BRENNEN (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BRENNEN
Last Name:SMICK
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1 BOONE ROAD
Mailing Address - Street 2:NAVAL HOSPITAL BREMERTON MEDICAL CREDITUALS
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1898
Mailing Address - Country:US
Mailing Address - Phone:360-475-4426
Mailing Address - Fax:360-475-4344
Practice Address - Street 1:1 BOONE ROAD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON MEDICAL CREDITUALS
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1898
Practice Address - Country:US
Practice Address - Phone:360-475-4426
Practice Address - Fax:360-475-4344
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2023-05-17
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Provider Licenses
StateLicense IDTaxonomies
WAOP000007022083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine