MEDICARE: DR. DEVON TYLER SMITH MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1285935502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVON TYLER SMITH MD

Provider Business Mailing Address
First Line	:	1884 9TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4704
Country	:	US
Telephone Number	:	407-342-4722
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 PARNASSUS AVE
Second Line	:	UNIVERSITY OF CALIFORNIA AT SAN FRANCISCO
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0244
Country	:	US
Telephone Number	:	415-476-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	02/11/2022

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