Provider Demographics
NPI:1417970260
Name:SMILOVITZ, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:SMILOVITZ
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:PO BOX 14210
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-4210
Mailing Address - Country:US
Mailing Address - Phone:805-543-2724
Mailing Address - Fax:805-543-5270
Practice Address - Street 1:1334 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3316
Practice Address - Country:US
Practice Address - Phone:805-543-2724
Practice Address - Fax:805-543-5270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17709207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G177090Medicaid
CABLUE SHIELDOtherBLUE SHIELD
CAG17709Medicare ID - Type UnspecifiedMEDICARE
CA00G177090Medicaid