Smith, Russel Donnan
Smith, Russel Donnan is an individual health care provider with primary practice located at 3567 Ne Tillamook St , Portland OR 97212-5158. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Smith, Russel Donnan can be contacted via phone (773) 810-9072.Contact Information
Primary practice address
3567 Ne Tillamook St
Portland OR 97212-5158
Phone: (773) 810-9072
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 2005012199 | Missouri |
Profile Details
| NPI number | 1962488585 |
|---|---|
| LBN Legal business name | Smith, Russel Donnan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 15th, 2005 |
| Last updated | Mar 23rd, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962488585 | NPPES |
| New York | MEDICAID | 00861014 |
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