MEDICARE: DR. DALLAS EDWARD SMITH M.D.

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	207P00000X	Emergency Medicine Physician	G74769	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326080565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS EDWARD SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60041
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91066-6041
Country	:	US
Telephone Number	:	626-447-0296
Fax Number	:	626-447-6057

Provider Business Practice Location Address
First Line	:	4929 VAN NUYS BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1702
Country	:	US
Telephone Number	:	818-907-4570
Fax Number	:	818-907-2814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/13/2008

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