Provider Demographics
NPI:1316946551
Name:SMALLEY, ALTON J (DPM)
Entity type:Individual
Prefix:DR
First Name:ALTON
Middle Name:J
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12140 NEW YORK RANCH ROAD
Mailing Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9344
Mailing Address - Country:US
Mailing Address - Phone:209-257-2400
Mailing Address - Fax:209-257-2403
Practice Address - Street 1:12140 NEW YORK RANCH ROAD
Practice Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9344
Practice Address - Country:US
Practice Address - Phone:209-257-2400
Practice Address - Fax:209-257-2403
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE2150213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00452685OtherNEW RR PROVIDER #
CA000E21500Medicaid
CA48006076OtherRR INDIVIDUAL PROV. #
CA0270150001Medicare NSC
CA48006076OtherRR INDIVIDUAL PROV. #
CA000E21504Medicare PIN
CA000E21500Medicare PIN