MEDICARE: KURT S 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	207L00000X	Anesthesiology Physician	MD00038649	WA
2	207L00000X	Anesthesiology Physician	G68214	CA

General Provider Information

NPI Number	:	1538115969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT S SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 782
Second Line	:
City	:	MAMMOTH LAKES
State	:	CA
Zip	:	93546-0782
Country	:	US
Telephone Number	:	206-200-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 SIERRA PARK RD.
Second Line	:
City	:	MAMMOTH LAKES
State	:	CA
Zip	:	93546
Country	:	US
Telephone Number	:	760-934-3311
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/27/2007

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