Provider Demographics
NPI:1538188206
Name:SMITH, EDWARD L (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:32322 COAST HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6785
Mailing Address - Country:US
Mailing Address - Phone:949-363-1800
Mailing Address - Fax:949-499-9998
Practice Address - Street 1:32322 COAST HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6785
Practice Address - Country:US
Practice Address - Phone:949-363-1800
Practice Address - Fax:949-499-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE61313Medicare UPIN
CA20A5748Medicare ID - Type Unspecified