Provider Demographics
NPI:1578509907
Name:SMITH, V ROY (MD)
Entity type:Individual
Prefix:
First Name:V
Middle Name:ROY
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 1:7797 N 1ST ST
Mailing Address - Street 2:PMB 18
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0962
Mailing Address - Country:US
Mailing Address - Phone:559-298-3540
Mailing Address - Fax:559-298-3540
Practice Address - Street 1:7797 N 1ST ST
Practice Address - Street 2:PMB 18
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0962
Practice Address - Country:US
Practice Address - Phone:559-298-3540
Practice Address - Fax:559-298-3540
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC36592207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36318Medicare UPIN
ZZZ70888ZMedicare ID - Type Unspecified