Douglas A Smith, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G42932 Issued in CA

Practice address

12340 Seal Beach Blvd # B641
Seal Beach, CA 90740-2792

Phone

(562) 596-6837

Fax

(562) 596-6837

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Los Angeles ENT Facial Plastics Center, Inc

  • Medical Specialty Clinic/Center
  • Redondo Beach, CA
  • NPI 1225463797
  NPD (past)
• William J Wickwire M D Inc a Professional Corporation

  • Dermatology Physician
  • Redondo Beach, CA
  • NPI 1326119165
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1497809396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5250",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907215250",
            "telephone_number": "562-596-6837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12340 SEAL BEACH BLVD # B641",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907402792",
            "telephone_number": "562-596-6837",
            "fax_number": "562-596-6837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DOUGLAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G42932",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G42932",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "G42932",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G42932",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CLIA",
            "identifier": "05D0554803",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G429321",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G429320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shohet Ear Associates Medical Group Inc
• Shoreline Mental Health, Inc
• Hilary Castelnau Siebens, MD
• Torunn E Sivesind, MD
• Sanford Jay Slater, PH.D.
• Gaylyn Smith, PHARMD
• Jayne Smith
• Nancy A Smith, MD
• Ravipan I Smith, D.D.S., M.S.
• Sandra Lee Smith, PH.D.

• Dermatology Physician in Seal Beach, CA
• Providers in Seal Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.