Provider Demographics
NPI:1780748590
Name:SMITH, PRUDENCE A (MD)
Entity type:Individual
Prefix:DR
First Name:PRUDENCE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5034
Mailing Address - Country:US
Mailing Address - Phone:597-414-5705
Mailing Address - Fax:
Practice Address - Street 1:869 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2207
Practice Address - Country:US
Practice Address - Phone:209-577-9900
Practice Address - Fax:209-577-1509
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA823972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45692Medicare UPIN