MEDICARE: DR. BARRY CHARLES 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	208000000X	Pediatrics Physician	G37917	CA

General Provider Information

NPI Number	:	1457710808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY CHARLES SMITH MD

Provider Business Mailing Address
First Line	:	10637 WILKINS AVE
Second Line	:	UNIT 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5870
Country	:	US
Telephone Number	:	310-717-4413
Fax Number	:

Provider Business Practice Location Address
First Line	:	10637 WILKINS AVE
Second Line	:	UNIT 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5870
Country	:	US
Telephone Number	:	310-717-4413
Fax Number	:

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

Provider Enumeration Date	:	02/14/2016
Last Update Date	:	02/15/2016

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