Provider Demographics
NPI:1265416077
Name:SMITH, STEVEN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
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 1:121 SOTOYOME STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4823
Mailing Address - Country:US
Mailing Address - Phone:707-525-4003
Mailing Address - Fax:707-578-6258
Practice Address - Street 1:121 SOTOYOME STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4823
Practice Address - Country:US
Practice Address - Phone:707-525-4003
Practice Address - Fax:707-578-6258
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46439207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464390OtherBLUE SHIELD OF CALIFORNIA
CAP00270356OtherRAILROAD MEDICARE
CA00G464390Medicaid
CA00G464391Medicare PIN
CAP00270356OtherRAILROAD MEDICARE
CAA89838Medicare UPIN
CA00G464390Medicaid