Individual
MR. DERRICK L. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
69730 HIGHWAY 111 STE 109, RANCHO MIRAGE, CA 92270-2873
(760) 778-6120
(760) 406-6077
Mailing address
PO BOX 1642, WILDOMAR, CA 92595-1642
(877) 240-3645
(951) 609-3706
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G50178
CA
2084P0800X
Psychiatry Physician
G50178
CA
208600000X
Surgery Physician
G50178
CA
Other
Enumeration date
09/14/2005
Last updated
09/15/2024
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