Provider Demographics
NPI:1003894213
Name:SMITH, CURTIS NATHANIEL SR (MD)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:NATHANIEL
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1253
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2617
Mailing Address - Country:US
Mailing Address - Phone:530-923-4401
Mailing Address - Fax:530-926-3791
Practice Address - Street 1:110 W CASTLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2206
Practice Address - Country:US
Practice Address - Phone:530-926-4401
Practice Address - Fax:530-926-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A30448OtherBLUE CROSS
CAP00464316OtherRAILROAD MEDICARE
CA00A304480Medicaid
A30448OtherBLUE CROSS
00A304481Medicare PIN