Healthcare Provider Details

I. General information

NPI: 1376599191
Provider Name (Legal Business Name): ERIC DAVID SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 EL CAMINO REAL STE 100
ATHERTON CA
94027-3803
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 650-364-3080
  • Fax: 650-364-2004
Mailing address:
  • Phone: 415-884-3418
  • Fax: 415-883-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA68606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: