Provider Demographics
NPI:1831301118
Name:RANDALL W. SMITH, M.D., APC
Entity Type:Organization
Organization Name:RANDALL W. SMITH, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-741-3809
Mailing Address - Street 1:1678 CLOVERDALE RD
Mailing Address - Street 2:GATE CODE 2503
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6717
Mailing Address - Country:US
Mailing Address - Phone:760-741-3809
Mailing Address - Fax:858-683-2022
Practice Address - Street 1:1678 CLOVERDALE RD
Practice Address - Street 2:GATE CODE 2503
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-6717
Practice Address - Country:US
Practice Address - Phone:760-741-3809
Practice Address - Fax:858-683-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20376207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty