Healthcare Provider Details

I. General information

NPI: 1548594542
Provider Name (Legal Business Name): DONALD RAY SMITH JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 302
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

5710 LEONA AVE APT 5
DALLAS TX
75231-5364
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5995
  • Fax: 415-666-3144
Mailing address:
  • Phone: 850-393-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58105
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2644
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4212-23
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08849
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number332886
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: