Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C27705 | CA |
NPI | 1336222355 |
---|---|
Provider Name | Dr. Don L Smith |
First Address | Santa Ana, CA 92701-2201 |
Second Address | Santa Ana, CA 92701-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C277050 | (05) | CA |
A87203 | (02) |