Provider Demographics
NPI:1114997277
Name:SMITH, ERIC PETRIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PETRIE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WELCH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1805
Mailing Address - Country:US
Mailing Address - Phone:650-325-6000
Mailing Address - Fax:
Practice Address - Street 1:900 WELCH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1805
Practice Address - Country:US
Practice Address - Phone:650-325-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36270207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology