Provider Demographics
NPI:1013954130
Name:SMITH, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3854
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1717
Mailing Address - Country:US
Mailing Address - Phone:310-863-0690
Mailing Address - Fax:310-492-9941
Practice Address - Street 1:5680 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8331
Practice Address - Country:US
Practice Address - Phone:559-374-5130
Practice Address - Fax:888-977-4918
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA50680207LA0401X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50680Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER