Provider Demographics
NPI:1962513200
Name:SMITH, ANDREW O (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:O
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 1:5904 NE 80TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1706
Mailing Address - Country:US
Mailing Address - Phone:425-306-1453
Mailing Address - Fax:
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-828-5396
Practice Address - Fax:360-828-5455
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD174493207L00000X
WAMD00039265207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0149361OtherLABOR & INDUSTRIES
WA1962513200Medicaid
WA8276412Medicaid
OR026003Medicaid