MEDICARE: JULIAN SHANE SMITH M.D.

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	2084P0800X	Psychiatry Physician	A95462	CA

General Provider Information

NPI Number	:	1316002892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN SHANE SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 942030
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75094-2030
Country	:	US
Telephone Number	:	858-405-6162
Fax Number	:	559-256-1081

Provider Business Practice Location Address
First Line	:	1410 F ST STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-1608
Country	:	US
Telephone Number	:	559-256-7600
Fax Number	:	559-256-1081

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	12/09/2022

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