MEDICARE: STACY R SMITH, MD APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G65407	CA

General Provider Information

NPI Number	:	1114357605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY R SMITH, MD APC

Provider Business Mailing Address
First Line	:	561 SAXONY PL
Second Line	:	SUITE 102
City	:	ENCINITAS
State	:	CA
Zip	:	92024-7700
Country	:	US
Telephone Number	:	760-203-3839
Fax Number	:	760-203-3840

Provider Business Practice Location Address
First Line	:	2371 LAGOON VIEW DR
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1507
Country	:	US
Telephone Number	:	619-787-5723
Fax Number	:	619-342-7428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STACY SMITH
Credential	:	MD
Telephone Number	:	760-203-3839

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/19/2013

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