Healthcare Provider Details

I. General information

NPI: 1801899398
Provider Name (Legal Business Name): RONALD W SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 LONG BEACH BLVD #440
LONG BEACH CA
90806-1590
US

IV. Provider business mailing address

3521 LOMITA BLVD STE 103
TORRANCE CA
90505-5041
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-9444
  • Fax: 562-988-0309
Mailing address:
  • Phone: 310-534-9131
  • Fax: 310-534-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA82278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: