MEDICARE: STEELE CLARKE 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	207Q00000X	Family Medicine Physician	C24221	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W22191	OTHER	CA	MEDICARE GROUP PTAN
2	WC24221C	OTHER	CA	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	05D0582567	OTHER	CA	CLIA
4	C24221	OTHER	CA	STATE LICENSE #

General Provider Information

NPI Number	:	1912000365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEELE CLARKE SMITH MD

Provider Business Mailing Address
First Line	:	3055 W ORANGE AVE
Second Line	:	SUITE 205
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3154
Country	:	US
Telephone Number	:	714-527-7707
Fax Number	:	714-527-8709

Provider Business Practice Location Address
First Line	:	3055 W ORANGE AVE
Second Line	:	SUITE 205
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3154
Country	:	US
Telephone Number	:	714-527-7707
Fax Number	:	714-527-8709

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	03/07/2023

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Directions to “ STEELE CLARKE SMITH MD” Practice Location

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