Provider Demographics
NPI:1598215493
Name:SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL
Entity Type:Organization
Organization Name:SUGAR PINE FAMILY MEDICINE P.C., PAUL SMITH, MD, ET AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-321-1044
Mailing Address - Street 1:5542 LONGLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1886
Mailing Address - Country:US
Mailing Address - Phone:775-321-1044
Mailing Address - Fax:775-851-6862
Practice Address - Street 1:5542 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1886
Practice Address - Country:US
Practice Address - Phone:775-321-1044
Practice Address - Fax:775-851-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty