Provider Demographics
NPI:1003966961
Name:SMITH, DAVID PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 E 1ST NORTH ST
Mailing Address - Street 2:SUITE 2 MAGNOLIA SQUARE
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6873
Mailing Address - Country:US
Mailing Address - Phone:843-871-1800
Mailing Address - Fax:843-871-5121
Practice Address - Street 1:133 E 1ST NORTH ST
Practice Address - Street 2:SUITE 2 MAGNOLIA SQUARE
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6873
Practice Address - Country:US
Practice Address - Phone:843-871-1800
Practice Address - Fax:843-871-5121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC142955Medicaid
SCE137190281Medicare UPIN