Healthcare Provider Details

I. General information

NPI: 1760411193
Provider Name (Legal Business Name): JOEL J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CONVOY ST SUITE 116
SAN DIEGO CA
92111-3738
US

IV. Provider business mailing address

PO BOX 15788
SAN DIEGO CA
92175-5788
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8110
  • Fax:
Mailing address:
  • Phone: 858-278-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG85004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberG85004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: