Provider Demographics
NPI:1952397796
Name:SMITH-HOEFER, ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:SMITH-HOEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 ANDERSON RD
Mailing Address - Street 2:#18
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3505
Mailing Address - Country:US
Mailing Address - Phone:530-771-4000
Mailing Address - Fax:530-771-4011
Practice Address - Street 1:635 ANDERSON RD
Practice Address - Street 2:#18
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-771-4000
Practice Address - Fax:530-771-4011
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CAG54090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G450901Medicaid
CAA49879Medicare UPIN
CA00G450901Medicaid