Provider Demographics
NPI:1124215348
Name:GREGORY G SMITH M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GREGORY G SMITH M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-688-3181
Mailing Address - Street 1:PO BOX 162267
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-2267
Mailing Address - Country:US
Mailing Address - Phone:916-688-3181
Mailing Address - Fax:916-688-3215
Practice Address - Street 1:7600 HOSPITAL DR STE G
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5406
Practice Address - Country:US
Practice Address - Phone:916-688-3181
Practice Address - Fax:916-688-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952322596OtherINDIVIDUAL NPI
CAZZZ96733ZMedicare PIN
CA1952322596OtherINDIVIDUAL NPI