Provider Demographics
NPI:1770787293
Name:GREGORY B. SMITH, M.D., A.P.C.
Entity type:Organization
Organization Name:GREGORY B. SMITH, M.D., A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-967-5721
Mailing Address - Street 1:6 WOODLAND RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9562
Mailing Address - Country:US
Mailing Address - Phone:707-967-5721
Mailing Address - Fax:707-967-5722
Practice Address - Street 1:6 WOODLAND RD STE 304
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9562
Practice Address - Country:US
Practice Address - Phone:707-967-5721
Practice Address - Fax:707-967-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51378Medicare UPIN