MEDICARE: G SMITH MD MEDICAL GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053418178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G SMITH MD MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	700 N PACIFIC COAST HWY
Second Line	:	SUITE # 203
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-978-3334
Fax Number	:	310-379-4632

Provider Business Practice Location Address
First Line	:	700 N PACIFIC COAST HWY
Second Line	:	SUITE # 203
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-978-3334
Fax Number	:	310-379-4632

Authorized Official
Title or Position	:	PRESDIENT
Name	:	DR. GREGORY A. SMITH
Credential	:	M.D.
Telephone Number	:	310-798-3334

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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