MEDICARE: DR. GREGORY DAW 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	208D00000X	General Practice Physician	G48979	CA

General Provider Information

NPI Number	:	1457444960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY DAW SMITH M.D.

Provider Business Mailing Address
First Line	:	2815 SUMMIT DRIVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025
Country	:	US
Telephone Number	:	760-480-6050
Fax Number	:	760-480-5527

Provider Business Practice Location Address
First Line	:	161 THUNDER DR STE 207
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6052
Country	:	US
Telephone Number	:	760-598-8410
Fax Number	:	760-598-8448

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/09/2008

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