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General NPI Number Information
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NPI Number | 1114357605
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Entity Type | Organization
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Legal Business Name | STACY R SMITH, MD APC
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 2371 LAGOON VIEW DR
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City | CARDIFF
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State | CA
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Zip | 92007-1507
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Country | US
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Telephone | 619-787-5723
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Fax | 619-342-7428
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Provider Business Mailing Address
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Address Line | 561 SAXONY PL SUITE 102
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City | ENCINITAS
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State | CA
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Zip | 92024-7700
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Country | US
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Telephone | 760-203-3839
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Fax | 760-203-3840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STACY SMITH
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Credential | MD
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Telephone | 760-203-3839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G65407
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License Number State | CA
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