Provider Demographics
NPI:1023045572
Name:SMITH, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RIVER OAKS DR STE 303
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9576
Mailing Address - Country:US
Mailing Address - Phone:601-936-0706
Mailing Address - Fax:601-936-6150
Practice Address - Street 1:1040 RIVER OAKS DR STE 303
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9576
Practice Address - Country:US
Practice Address - Phone:601-936-0706
Practice Address - Fax:601-936-6150
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05323207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0125737Medicaid
MS440000020Medicare ID - Type Unspecified
MS0125737Medicaid