Provider Demographics
NPI:1457444960
Name:SMITH, GREGORY DAW (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAW
Last Name:SMITH
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 1:2815 SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-480-6050
Mailing Address - Fax:760-480-5527
Practice Address - Street 1:161 THUNDER DR STE 207
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6052
Practice Address - Country:US
Practice Address - Phone:760-598-8410
Practice Address - Fax:760-598-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48979208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48979Medicare ID - Type Unspecified
CAA51234Medicare UPIN