Provider Demographics
NPI:1316002892
Name:SMITH, JULIAN SHANE (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:SHANE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 942030
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-2030
Mailing Address - Country:US
Mailing Address - Phone:858-405-6162
Mailing Address - Fax:559-256-1081
Practice Address - Street 1:1410 F ST STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1608
Practice Address - Country:US
Practice Address - Phone:559-256-7600
Practice Address - Fax:559-256-1081
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA954622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry