Provider Demographics
NPI:1245490358
Name:SMOOT, CHARLES BARTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BARTON
Last Name:SMOOT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2323
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:1809 NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2196
Practice Address - Country:US
Practice Address - Phone:619-515-2300
Practice Address - Fax:619-234-2447
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2010-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA97036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine