Provider Demographics
NPI:1790761054
Name:SMITH-NASH, BARBARA J (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:SMITH-NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 LAGUNA BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7904
Mailing Address - Country:US
Mailing Address - Phone:916-683-3955
Mailing Address - Fax:
Practice Address - Street 1:8110 LAGUNA BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7904
Practice Address - Country:US
Practice Address - Phone:916-683-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG035333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G353330Medicare PIN
CAA89599Medicare UPIN