Provider Demographics
NPI:1023082971
Name:SMITH, MONT ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MONT
Middle Name:ANTHONY
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 1:2675 E SLAUSON AVENUE
Mailing Address - Street 2:ALL CARE MEDICAL GROUP INC
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-589-6681
Mailing Address - Fax:323-584-2505
Practice Address - Street 1:2675 E SLAUSON AVENUE
Practice Address - Street 2:ALL CARE MEDICAL GROUP INC
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-589-6681
Practice Address - Fax:323-584-2505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41618208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040370Medicaid
CAGR0040370Medicaid
CAW849Medicare ID - Type Unspecified