Healthcare Provider Details

I. General information

NPI: 1760835086
Provider Name (Legal Business Name): DR. GREGORY A. SMITH, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 N FRESNO ST STE 105
FRESNO CA
93710-8331
US

IV. Provider business mailing address

PO BOX 3854
REDONDO BEACH CA
90277-1717
US

V. Phone/Fax

Practice location:
  • Phone: 559-374-5130
  • Fax: 888-988-8315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA50680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77153
License Number StateCA

VIII. Authorized Official

Name: DR. GREGORY ALAN SMITH
Title or Position: PRESIDENT AND MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-863-0690