Organization
CLARK E. SMITH, M.D. A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARK E. SMITH M.D. (OWNER)
(858) 530-9112
Entity
Organization
Contact information
Practice address
9820 WILLOW CREEK RD, SUITE 370, SAN DIEGO, CA 92131
(858) 530-9112
(858) 530-9118
Mailing address
9820 WILLOW CREEK RD, SUITE 370, SAN DIEGO, CA 92131
(858) 530-9112
(858) 530-9118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G49105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G491050
—
CA
Enumeration date
05/01/2009
Last updated
05/22/2009
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