Provider Demographics
NPI:1982773099
Name:SMITH, EVA MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1305
Mailing Address - Country:US
Mailing Address - Phone:530-625-9283
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-5171
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE42592207QA0401X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G98275Medicare UPIN