Provider Demographics
NPI:1942391982
Name:SMITH, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:635 ANDERSON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-758-1122
Practice Address - Fax:530-758-1646
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-07-10
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Provider Licenses
StateLicense IDTaxonomies
CAG52833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528330Medicaid
CA00G528330Medicaid
CA00G528331Medicare PIN
A52362Medicare UPIN