Provider Demographics
NPI:1962507681
Name:SMITH, LAUREN G (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:G
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 1:572 RIO LINDO AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-893-1127
Mailing Address - Fax:530-893-1128
Practice Address - Street 1:572 RIO LINDO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-893-1127
Practice Address - Fax:530-893-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC347400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C347400Medicare ID - Type Unspecified
A35715Medicare UPIN