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General NPI Number Information
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NPI Number | 1548622194
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Entity Type | Individual
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Provider Name | BLAIR SMART MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | USC GENERAL SURGERY RESIDENCY PROGRAM 1520 SAN PABLO STREET
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City | LOS ANGELES
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State | CA
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Zip | 90033-5330
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Country | US
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Telephone | 989-878-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 4322 GARDEN HOMES AVE
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City | LOS ANGELES
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State | CA
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Zip | 90032-1110
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Country | US
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Telephone | 989-878-0093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A155237
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License Number State | CA
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