=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306028329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN F SMOOT MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 11/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2645 OCEAN AVE SUITE 301
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-585-5492
-----------------------------------------------------
Fax | 415-585-5422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2645 OCEAN AVE SUITE 301
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-585-5492
-----------------------------------------------------
Fax | 415-585-5422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALLEN F SMOOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-585-5492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A19498
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------