Provider Demographics
NPI:1962504076
Name:SMITH, FORREST (MD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 SANTA RITA RD STE B
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5667
Mailing Address - Country:US
Mailing Address - Phone:925-734-0100
Mailing Address - Fax:925-734-0207
Practice Address - Street 1:1393 SANTA RITA RD STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5667
Practice Address - Country:US
Practice Address - Phone:925-734-0100
Practice Address - Fax:925-734-0207
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35811207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C358110Medicaid
CAA36076Medicare UPIN
CA00C358110Medicaid