Healthcare Provider Details

I. General information

NPI: 1215022736
Provider Name (Legal Business Name): GEORGE H SMALL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GEORGE H SMALL M.D.

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTERN AVE STE 101
SAN BERNARDINO CA
92411-1352
US

IV. Provider business mailing address

PO BOX 10999-0999
SAN BERNARDINO CA
92423
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-1542
  • Fax: 909-327-2756
Mailing address:
  • Phone: 909-528-3639
  • Fax: 909-783-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA34324
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA34324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: