Provider Demographics
NPI:1073538583
Name:SMITH, TERRY L (DPM)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 FORTUNE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7847
Mailing Address - Country:US
Mailing Address - Phone:530-888-1118
Mailing Address - Fax:530-888-8832
Practice Address - Street 1:3272 FORTUNE CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7847
Practice Address - Country:US
Practice Address - Phone:530-888-1118
Practice Address - Fax:530-888-8832
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00E2980213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI11540Medicare UPIN
CA000E29802Medicare ID - Type Unspecified