Provider Demographics
NPI:1467644013
Name:CRAIG V SMITH M.D. INC.
Entity Type:Organization
Organization Name:CRAIG V SMITH M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:323-667-0660
Mailing Address - Street 1:866 N VERMONT AVE
Mailing Address - Street 2:3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3587
Mailing Address - Country:US
Mailing Address - Phone:323-667-0660
Mailing Address - Fax:323-660-7027
Practice Address - Street 1:866 N VERMONT AVE
Practice Address - Street 2:3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:323-667-0660
Practice Address - Fax:323-660-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61164208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61164OtherMEDICAL CERTIFICATE