MEDICARE: DR. JOEL J 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	207X00000X	Orthopaedic Surgery Physician	G85004	CA
2	207XX0801X	Orthopaedic Trauma Physician	G85004	CA

General Provider Information

NPI Number	:	1760411193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL J SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 15788
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92175-5788
Country	:	US
Telephone Number	:	858-278-8110
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 CONVOY ST
Second Line	:	SUITE 116
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3738
Country	:	US
Telephone Number	:	858-278-8110
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/08/2020

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