Provider Demographics
NPI:1073565560
Name:SMYTH-MEDINA, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:SMYTH-MEDINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 341
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-365-0606
Mailing Address - Fax:818-898-0205
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 341
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-365-0606
Practice Address - Fax:818-898-0205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48784207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW613Medicare ID - Type Unspecified
CAF86529Medicare UPIN