Provider Demographics
NPI:1306894381
Name:SMART, JOSEPH HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HOWARD
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4194 CALLE MAR DE BALLENAS
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-499-2701
Practice Address - Fax:858-521-2008
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077755208000000X
OH35-076473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G777550Medicaid
CA00G777550Medicaid