Provider Demographics
NPI:1316138506
Name:SMITH, ALEXA REEVES (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:REEVES
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXA
Other - Middle Name:LYNNE
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:114 C AVE
Mailing Address - Street 2:# 105
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1435
Mailing Address - Country:US
Mailing Address - Phone:619-762-3220
Mailing Address - Fax:
Practice Address - Street 1:5395 RUFFIN RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1338
Practice Address - Country:US
Practice Address - Phone:619-762-3220
Practice Address - Fax:844-836-9800
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0029116207T00000X
CAA104553207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4671915337OtherMYUTMB 4671915337