Provider Demographics
NPI:1356856538
Name:TYLER G. SMITH, MD. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TYLER G. SMITH, MD. A PROFESSIONAL CORPORATION
Other - Org Name:SIERRA SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-352-0016
Mailing Address - Street 1:5 MEDICAL PLAZA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2866
Mailing Address - Country:US
Mailing Address - Phone:916-352-0016
Mailing Address - Fax:916-299-0032
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2866
Practice Address - Country:US
Practice Address - Phone:916-352-0016
Practice Address - Fax:916-299-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108880207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108880OtherLICENSE NUMBER