Basic Information
| Provider Information | |||||||||
| NPI: | 1588622542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMURR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EARL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 BARBOZA ST | ||||||||
| Address2: | |||||||||
| City: | MENDOTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596555000 | ||||||||
| FaxNumber: | 5596556818 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 BARBOZA ST | ||||||||
| Address2: | |||||||||
| City: | MENDOTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596555000 | ||||||||
| FaxNumber: | 5596556818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G75739 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G757390 | 01 | MEDICAL | OTHER |