Provider Demographics
NPI:1396241147
Name:SMITH, PHOEBE L (MD)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:652 PETALUMA AVE STE H
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4266
Mailing Address - Country:US
Mailing Address - Phone:520-437-9346
Mailing Address - Fax:707-869-8170
Practice Address - Street 1:652 PETALUMA AVE STE H
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4266
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:707-869-8170
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA164367207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA164367OtherTHE MEDICAL BOARD OF CALIFORNIA