Provider Demographics
NPI:1053418178
Name:G SMITH MD MEDICAL GROUP INC.
Entity type:Organization
Organization Name:G SMITH MD MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-798-3334
Mailing Address - Street 1:700 N PACIFIC COAST HWY
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2167
Mailing Address - Country:US
Mailing Address - Phone:310-978-3334
Mailing Address - Fax:310-379-4632
Practice Address - Street 1:700 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE # 203
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2167
Practice Address - Country:US
Practice Address - Phone:310-978-3334
Practice Address - Fax:310-379-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18002Medicare ID - Type UnspecifiedMEDICARE