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NPI Code Detail

MEDICARE: DR. DOUGLAS CHARLES SMITH M.D.

MEDICARE: DR. DOUGLAS CHARLES 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
1174400000XSpecialistA51642CA

General Provider Information

NPI Number : 1932212529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS CHARLES SMITH M.D.
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 2699 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2710
Country : US
Telephone Number : 562-426-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 01/11/2026

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