MEDICARE: DR. EDWARD L SMITH D.O.

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	207Q00000X	Family Medicine Physician	20A5748	CA

General Provider Information

NPI Number	:	1538188206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD L SMITH D.O.

Provider Business Mailing Address
First Line	:	32322 COAST HWY
Second Line	:	SUITE B
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6785
Country	:	US
Telephone Number	:	949-363-1800
Fax Number	:	949-499-9998

Provider Business Practice Location Address
First Line	:	32322 COAST HWY
Second Line	:	SUITE B
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6785
Country	:	US
Telephone Number	:	949-363-1800
Fax Number	:	949-499-9998

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/11/2022

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