Provider Demographics
NPI:1174596233
Name:SMALLEY, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:931 BUENA VISTA ST
Mailing Address - Street 2:405
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1723
Mailing Address - Country:US
Mailing Address - Phone:626-358-8901
Mailing Address - Fax:626-358-7389
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:405
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-358-8901
Practice Address - Fax:626-358-7389
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAC42265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
222773062Medicare ID - Type Unspecified
CAA88300Medicare UPIN