Provider Demographics
NPI:1871550020
Name:SMITH, DANNY (CRNA)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 SW WESTGATE DR
Mailing Address - Street 2:#241
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2432
Mailing Address - Country:US
Mailing Address - Phone:503-297-7223
Mailing Address - Fax:503-297-7603
Practice Address - Street 1:1050 SOUTHGATE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081034405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR170373Medicaid
OR082687000OtherREGENCE BCBSO
OR0000CRBCQMedicare ID - Type Unspecified
OR082687000OtherREGENCE BCBSO