Provider Demographics
NPI:1093767865
Name:SMITH, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-8559
Mailing Address - Country:US
Mailing Address - Phone:817-332-9957
Mailing Address - Fax:817-336-3130
Practice Address - Street 1:757 8TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2522
Practice Address - Country:US
Practice Address - Phone:817-332-9957
Practice Address - Fax:817-336-3130
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH50692086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097299401Medicaid
TXD79998Medicare UPIN
TX097299401Medicaid