Provider Demographics
NPI:1043256779
Name:SMITH, WENDEL J (MD)
Entity type:Individual
Prefix:DR
First Name:WENDEL
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2410 17TH ST NW
Mailing Address - Street 2:UNIT 307
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2764
Mailing Address - Country:US
Mailing Address - Phone:206-669-6610
Mailing Address - Fax:253-200-0907
Practice Address - Street 1:3015 N 33RD ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6420
Practice Address - Country:US
Practice Address - Phone:253-759-8500
Practice Address - Fax:253-200-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036712208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0191192OtherSTATE L&I
WA8231649Medicaid
WAG8850662Medicare PIN
E59808Medicare UPIN