Basic Information
| Provider Information | |||||||||
| NPI: | 1508872714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH-ZAGONE | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | JENNIFER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072693617 | ||||||||
| FaxNumber: | 7072693889 | ||||||||
| Practice Location | |||||||||
| Address1: | 2425 HARRISON AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072693617 | ||||||||
| FaxNumber: | 7072693889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 02/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | A89551 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ZD0900X | A89551 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | A89551 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.