Healthcare Provider Details

I. General information

NPI: 1740737808
Provider Name (Legal Business Name): STEPHEN JOEL SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

IV. Provider business mailing address

4110 WINDING BLUFF LN
SACRAMENTO CA
95841-4426
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-7145
  • Fax: 916-903-7839
Mailing address:
  • Phone: 423-762-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: