1235230525 NPI number — DR. ELIZABETH MARSHALL SMITH MD

Table of content: MR. GEORGE M. WHITESIDE L.AC. (NPI 1376539015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235230525 NPI number — DR. ELIZABETH MARSHALL SMITH MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPENCER-SMITH
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235230525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 SIR FRANCIS DRAKE BLVD
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
GREENBRAE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-464-9604
Provider Business Mailing Address Fax Number:
415-464-0171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 SIR FRANCIS DRAKE BLVD
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
GREENBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-464-9604
Provider Business Practice Location Address Fax Number:
415-464-0171
Provider Enumeration Date:
09/26/2006

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: 207RR0500X , with the licence number:  C34263 , 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: C342630 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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