Provider Demographics
NPI:1548622194
Name:SMART, BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USC GENERAL SURGERY RESIDENCY PROGRAM
Mailing Address - Street 2:1520 SAN PABLO STREET
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5330
Mailing Address - Country:US
Mailing Address - Phone:989-878-0093
Mailing Address - Fax:
Practice Address - Street 1:USC GENERAL SURGERY RESIDENCY PROGRAM
Practice Address - Street 2:1520 SAN PABLO STREET
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5330
Practice Address - Country:US
Practice Address - Phone:989-878-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155237208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery