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General NPI Number Information
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NPI Number | 1467649434
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Entity Type | Organization
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Legal Business Name | J. NEVIN SMITH, M.D., INC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 181 ANDRIEUX ST SUITE 107
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City | SONOMA
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State | CA
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Zip | 95476-6932
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Country | US
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Telephone | 707-938-1040
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Fax | 707-938-0942
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Provider Business Mailing Address
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Address Line | 181 ANDRIEUX ST SUITE 107
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City | SONOMA
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State | CA
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Zip | 95476-6932
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Country | US
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Telephone | 707-938-1040
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Fax | 707-938-0942
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Authorized Official
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Title or Position | CEO
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Name | DR. JOSEPH NEVIN SMITH
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Credential | M.D.
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Telephone | 707-938-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G92350
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License Number State | CA
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