Basic Information
Provider Information
NPI: 1184839722
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: APISARNTHANARAX
FirstName: SMITH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 50095
Address2:  
City: SEATTLE
State: WA
PostalCode: 981455095
CountryCode: US
TelephoneNumber: 2065436420
FaxNumber:  
Practice Location
Address1: 1570 N 115TH ST
Address2:  
City: SEATTLE
State: WA
PostalCode: 981338401
CountryCode: US
TelephoneNumber: 2063062804
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2007
LastUpdateDate: 05/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XMD60335889WAY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

ID Information
IDTypeStateIssuerDescription
118483972205WA MEDICAID


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