Provider Demographics
NPI:1265798656
Name:SMITH, CHARLES AUSTIN (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3174
Mailing Address - Country:US
Mailing Address - Phone:866-764-7330
Mailing Address - Fax:888-974-1469
Practice Address - Street 1:501 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3174
Practice Address - Country:US
Practice Address - Phone:866-764-7330
Practice Address - Fax:888-974-1469
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57551207R00000X
GA74597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine