=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487677670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD T SMITH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5974 PENTZ RD
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95969-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-877-4649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 385
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95967-0385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-877-4649
-----------------------------------------------------
Fax | 530-877-4649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G24169
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G24169
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------