Michael Benjamin Smith, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10004669 Issued in WA

Practice address

2505 S Denver St
Fairchild AFB, WA 99011-8650

Phone

(590) 247-5414

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124074943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10012 S STANGLAND RD",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990229409",
            "telephone_number": "509-299-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 S DENVER ST",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "990118650",
            "telephone_number": "590-247-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE MED LICENSE",
            "identifier": "PA10004669",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA NUMBER",
            "identifier": "1030141",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Montana Renee Rickey, PHARM. D
• Wandalyz Rivera de Jesus, MSW
• Kerilyn Shigihara, IDMT
• Robert Michael Siebenaler, IDMT
• Camilla Deann Smith, RN
• Peggy Smith, ARNP
• Ariel Kaye Soderberg, LMT
• Gene J Sonnenburg Jr., IDMT
• George Walker Stayer, MD
• Michael Thomas Stevens

• Physician Assistant in Fairchild AFB, WA
• Providers in Fairchild AFB, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.