1598784951 NPI number — DR. LEONARD F SMITH MD

Table of content: DR. LEONARD F SMITH MD (NPI 1598784951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598784951 NPI number — DR. LEONARD F SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LEONARD
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598784951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 W GIBSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-666-1631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 W GIBSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-666-1631
Provider Business Practice Location Address Fax Number:
530-668-2697
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G43594 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G435940 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 080086123 . This is a "RR MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G435940 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".