Healthcare Provider Details

I. General information

NPI: 1487546636
Provider Name (Legal Business Name): BLAIR SMART MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 GARDEN HOMES AVE
LOS ANGELES CA
90032-1110
US

IV. Provider business mailing address

4322 GARDEN HOMES AVE
LOS ANGELES CA
90032-1110
US

V. Phone/Fax

Practice location:
  • Phone: 989-878-0093
  • Fax:
Mailing address:
  • Phone: 989-878-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAIR SMART
Title or Position: CEO
Credential: MD
Phone: 989-878-0093