Basic Information
Provider Information | |||||||||
NPI: | 1477554756 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SMITH SINGARES | ||||||||
FirstName: | EDUARDO | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SMITH SINGARES | ||||||||
OtherFirstName: | EDUARDO | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 550 GAGE BLVD STE 101 | ||||||||
Address2: |   | ||||||||
City: | RICHLAND | ||||||||
State: | WA | ||||||||
PostalCode: | 993529532 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099423627 | ||||||||
FaxNumber: | 5096272983 | ||||||||
Practice Location | |||||||||
Address1: | 888 SWIFT BLVD | ||||||||
Address2: |   | ||||||||
City: | RICHLAND | ||||||||
State: | WA | ||||||||
PostalCode: | 993523514 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099464611 | ||||||||
FaxNumber: | 5099422812 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2005 | ||||||||
LastUpdateDate: | 01/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A2900X | MD60993057 | WA | N |   |   |   |   | 2084A2900X | 036-117728 | IL | N |   |   |   |   | 208600000X | 036-117728 | IL | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | 036-117728 | IL | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MD60993057 | WA | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | MD60993057 | WA | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
No ID Information.