Basic Information
| Provider Information | |||||||||
| NPI: | 1235183856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 NORTH FINE STREET | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575231 | ||||||||
| FaxNumber: | 5594575896 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 DIVISADERO | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575900 | ||||||||
| FaxNumber: | 5594575992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A4038 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.