Stacy R. Smith, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G65407 Issued in CA

Practice address

561 Saxony PL
Suite 102
Encinitas, CA 92024-7700

Phone

(760) 203-3839

Fax

(760) 203-3840

NPI assigned

Mar 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1780651760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 SAXONY PL",
            "address_2": "SUITE 102",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920247700",
            "telephone_number": "760-203-3839",
            "fax_number": "760-203-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 SAXONY PL",
            "address_2": "SUITE 102",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920247700",
            "telephone_number": "760-203-3839",
            "fax_number": "760-203-3840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G65407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G65407",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Vanfleet Smith, P.T.
• Justin Roger Smith, DMD
• Kevin M Smith, M.D.
• Marcy Smith
• Margaret Elaine Smith, MD
• Chelsea Smithback, ND
• Mara A Snee, PA-C, MPAP
• SNH Cal Tenant LLC
• James A Snow, DDS
• Julie L Snyder Block, M.D.

• Dermatology Physician in Encinitas, CA
• Providers in Encinitas, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.