Provider Demographics
NPI:1306028329
Name:ALLEN F SMOOT MD INC
Entity Type:Organization
Organization Name:ALLEN F SMOOT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-585-5492
Mailing Address - Street 1:2645 OCEAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1647
Mailing Address - Country:US
Mailing Address - Phone:415-585-5492
Mailing Address - Fax:415-585-5422
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1647
Practice Address - Country:US
Practice Address - Phone:415-585-5492
Practice Address - Fax:415-585-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A86079Medicare UPIN
00A194980Medicare PIN