Healthcare Provider Details

I. General information

NPI: 1710088752
Provider Name (Legal Business Name): MARK A. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1100 N PALM CANYON DR SUITE 211
PALM SPRINGS CA
92262-4414
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8000
  • Fax: 855-211-3729
Mailing address:
  • Phone: 760-320-9019
  • Fax: 760-320-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00G470110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG47011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: