Healthcare Provider Details

I. General information

NPI: 1952397796
Provider Name (Legal Business Name): ELISE SMITH-HOEFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

635 ANDERSON RD #18
DAVIS CA
95616-3505
US

IV. Provider business mailing address

635 ANDERSON RD #18
DAVIS CA
95616-3505
US

V. Phone/Fax

Practice location:
  • Phone: 530-771-4000
  • Fax: 530-771-4011
Mailing address:
  • Phone: 530-771-4000
  • Fax: 530-771-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG54090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: