Provider Demographics
NPI:1912000365
Name:SMITH, STEELE CLARKE (MD)
Entity Type:Individual
Prefix:
First Name:STEELE
Middle Name:CLARKE
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 1:3055 W ORANGE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3154
Mailing Address - Country:US
Mailing Address - Phone:714-527-7707
Mailing Address - Fax:714-527-8709
Practice Address - Street 1:3055 W ORANGE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3154
Practice Address - Country:US
Practice Address - Phone:714-527-7707
Practice Address - Fax:714-527-8709
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22191OtherMEDICARE GROUP PTAN
CAWC24221COtherMEDICARE INDIVIDUAL PTAN
CA05D0582567OtherCLIA
CAC24221OtherSTATE LICENSE #
CAC24221OtherSTATE LICENSE #
CAC24221OtherSTATE LICENSE #