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General NPI Number Information
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NPI Number | 1780050278
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Entity Type | Organization
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Legal Business Name | CRAIG V. SMITH, M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 6711 MELROSE AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90038
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Country | US
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Telephone | 323-307-7220
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Fax | 213-403-4685
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Provider Business Mailing Address
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Address Line | 6711 MELROSE AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90038
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Country | US
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Telephone | 323-307-7220
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Fax | 213-403-4685
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Authorized Official
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Title or Position | CEO
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Name | CRAIG SMITH
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Credential | M.D.
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Telephone | 323-307-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 61164
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 61164
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License Number State | CA
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