Provider Demographics
NPI:1154485985
Name:SMETHURST, PETER ROY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROY
Last Name:SMETHURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:714-919-8804
Practice Address - Street 1:1010 W LA VETA AVE STE 750
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4312
Practice Address - Country:US
Practice Address - Phone:714-639-9401
Practice Address - Fax:714-919-8804
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77515207R00000X, 207RP1001X, 207RC0200X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0003350Medicaid
CA1912919804Medicaid
CACG5665OtherRAILROAD MEDICARE - GROUP PTAN
1912919804OtherNPI - TYPE 2
CAP00855924OtherRAILROAD MEDICARE - PROVIDER PTAN
CAW1514OtherMEDICARE PTAN - TYPE 2
CACG5665OtherRAILROAD MEDICARE - GROUP PTAN