Provider Demographics
NPI:1598750259
Name:SMITH, GARRETT ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:ANDREW
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 1:55 FRANCISCO STREET
Mailing Address - Street 2:#700
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2111
Mailing Address - Country:US
Mailing Address - Phone:415-682-0843
Mailing Address - Fax:415-682-0880
Practice Address - Street 1:55 FRANCISCO STREET
Practice Address - Street 2:#700
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2111
Practice Address - Country:US
Practice Address - Phone:415-682-0843
Practice Address - Fax:415-682-0880
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49288207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A492880Medicaid
F22318Medicare UPIN
CA00A492880Medicare PIN