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Individual
MARK ALLAN SMITH
Active
Individual
MARK ALLAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A72221
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1915
FQHC MEDICARE PART A
CA
01
—
55-1975
FQHC MEDICARE PART A
CA
05
—
FHC70543G
—
CA
05
—
FHC71021F
—
CA
01
—
HAP70543G
FPACT
CA
01
—
HAP71021F
FPACT
CA
01
—
ZZZ23222Z
FQHC MEDICARE PART B
CA
01
—
ZZZ29799Z
FQHC MEDICARE PART B
CA
Enumeration date
09/06/2006
Last updated
05/30/2013
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