Basic Information
| Provider Information | |||||||||
| NPI: | 1861401002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | STUART | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 AVENIDA ENCINAS STE 200 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920084383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604391963 | ||||||||
| FaxNumber: | 7602680931 | ||||||||
| Practice Location | |||||||||
| Address1: | 4002 VISTA WAY | ||||||||
| Address2: | EMERGENCY DEPT. | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604391963 | ||||||||
| FaxNumber: | 7602680931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 01/10/2014 | ||||||||
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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 | 207P00000X | 20A8897 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.