Provider Demographics
NPI:1942825435
Name:SMITH, CONNER MARTIN (DO)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:MARTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CHERRY AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4201
Mailing Address - Country:US
Mailing Address - Phone:360-479-2360
Mailing Address - Fax:360-479-4038
Practice Address - Street 1:2601 CHERRY AVE STE 315
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4201
Practice Address - Country:US
Practice Address - Phone:360-479-2360
Practice Address - Fax:360-479-4038
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61585913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2210215Medicaid