Individual
DR. DOUGLAS A SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12340 SEAL BEACH BLVD # B641, SEAL BEACH, CA 90740-2792
(562) 596-6837
(562) 596-6837
Mailing address
PO BOX 5250, LOS ALAMITOS, CA 90721-5250
(562) 596-6837
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G42932
CA
207ND0900X
Dermatopathology Physician
G42932
CA
207NP0225X
Pediatric Dermatology Physician
G42932
CA
207NS0135X
Procedural Dermatology Physician
G42932
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G429320
—
CA
05
—
00G429321
—
CA
01
—
05D0554803
CMS CLIA
—
Enumeration date
01/22/2007
Last updated
03/23/2017
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