Provider Demographics
NPI:1891990552
Name:SMITH, LORA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:MICHELLE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-392-8200
Mailing Address - Fax:415-392-8201
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 1212
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-392-8200
Practice Address - Fax:415-392-8201
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant