Provider Demographics
NPI:1275523607
Name:SMUKLER, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:SMUKLER
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 1:3116 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5638
Mailing Address - Country:US
Mailing Address - Phone:707-444-3885
Mailing Address - Fax:707-444-3917
Practice Address - Street 1:3116 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5638
Practice Address - Country:US
Practice Address - Phone:707-444-3885
Practice Address - Fax:707-444-3917
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G381060Medicaid
CA00G381062Medicare PIN
CA00G381060Medicaid