Provider Demographics
NPI:1871341545
Name:SMITH, REGINALD RICHARD JR
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:RICHARD
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W NORA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4579
Mailing Address - Country:US
Mailing Address - Phone:509-869-0724
Mailing Address - Fax:
Practice Address - Street 1:901 N MONROE ST STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2148
Practice Address - Country:US
Practice Address - Phone:509-413-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist