Organization
THOMAS E SMITH DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E SMITH DPM (OWNER)
(909) 599-0981
Entity
Organization
Contact information
Practice address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738
Mailing address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738
Taxonomy
Speciality
Code
Description
License number
State
213EP0504X
Public Medicine Podiatrist
Primary
E2504
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG3139
PALMETTO GBA
CA
05
—
GRE000060
—
CA
01
—
W20893
MEDICARE PTAN
CA
Enumeration date
11/30/2006
Last updated
09/09/2010
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