Provider Demographics
NPI:1548259385
Name:JOHN P SMITH MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOHN P SMITH MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:408-406-1895
Mailing Address - Street 1:1530 MONTEVAL PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5714
Mailing Address - Country:US
Mailing Address - Phone:408-406-1895
Mailing Address - Fax:408-268-7814
Practice Address - Street 1:14911 NATIONAL AVE
Practice Address - Street 2:STE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-358-3448
Practice Address - Fax:408-356-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082830Medicaid
CACF8105OtherRAILROAD MEDICARE
CACF8105OtherRAILROAD MEDICARE