Provider Demographics
NPI:1992817936
Name:SMITH, LONNIE RAY (MD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:RAY
Last Name:SMITH
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 1:470 E CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-1509
Mailing Address - Country:US
Mailing Address - Phone:559-688-7614
Mailing Address - Fax:
Practice Address - Street 1:1066 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-686-2599
Practice Address - Fax:559-686-5206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG516370207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G516371Medicaid
CA1730494634OtherNPI-TYPE 2
CA1730494634OtherNPI-TYPE 2
CA00G516371Medicaid
CAA93095Medicare UPIN