Healthcare Provider Details

I. General information

NPI: 1114124856
Provider Name (Legal Business Name): MR. ANTHONY EUGENE SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HEGENBERGER RD SUITE 600
OAKLAND CA
94621-1420
US

IV. Provider business mailing address

1546 VAN DYKE AVE
SAN FRANCISCO CA
94124-3235
US

V. Phone/Fax

Practice location:
  • Phone: 510-383-1653
  • Fax: 510-383-1616
Mailing address:
  • Phone: 510-383-1653
  • Fax: 510-383-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: