Smith, Larry Alan

Smith, Larry Alan is an individual health care provider with primary practice located at 1041 4Th St Ste B, Santa Rosa CA 95404. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Smith, Larry Alan can be contacted via phone (707) 526-4777.

Contact Information

Primary practice address
1041 4Th St Ste B Santa Rosa CA 95404
Phone: (707) 526-4777
Fax: (707) 526-8809
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 000E21510 California

Profile Details

NPI number 1609979822
LBN Legal business name Smith, Larry Alan
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2006
Last updated May 8th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609979822 NPPES
California MEDICAID 7704019

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