Individual
DR. EVELYN RENEE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
842 CALIFORNIA BLVD, SAN LUIS OBISPO, CA 93401-2902
(805) 542-9678
(805) 542-9685
Mailing address
842 CALIFORNIA BLVD, SAN LUIS OBISPO, CA 93401-2902
(805) 542-9678
(805) 547-1626
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G77320
CA
207X00000X
Orthopaedic Surgery Physician
MD223766
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000067751
MEDICARE GROUP PTAN
UT
01
—
56-2593593
CIGNA HEALTHCARE
CA
01
—
616024300
ACS/US DEPT LABOR
UT
01
—
FL915Z
MEDICARE PTAN
CA
Enumeration date
06/01/2006
Last updated
03/21/2025
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