Provider Demographics
NPI:1346252558
Name:SMITH, ALISON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 SE WASHINGTON ST
Mailing Address - Street 2:PO BOX 378
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2829
Mailing Address - Country:US
Mailing Address - Phone:503-623-7301
Mailing Address - Fax:503-831-3473
Practice Address - Street 1:770 TAMALPAIS DR
Practice Address - Street 2:SUITE 402
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1700
Practice Address - Country:US
Practice Address - Phone:415-927-7900
Practice Address - Fax:415-927-7925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23307ZMedicare ID - Type Unspecified
CAE34154Medicare UPIN