Provider Demographics
NPI:1730494634
Name:LONNIE R. SMITH, M.D., INC
Entity type:Organization
Organization Name:LONNIE R. SMITH, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-686-2599
Mailing Address - Street 1:1066 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2251
Mailing Address - Country:US
Mailing Address - Phone:559-686-2599
Mailing Address - Fax:559-686-5206
Practice Address - Street 1:1066 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-686-2599
Practice Address - Fax:559-686-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992817936OtherNPI
CA00G516371Medicaid
CAG51637OtherLICENSE
CAG51637OtherLICENSE
CA1992817936OtherNPI