Provider Demographics
NPI:1235100215
Name:SMITH, DAVID MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARC
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 1:2700 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1281
Mailing Address - Country:US
Mailing Address - Phone:541-584-2345
Mailing Address - Fax:541-584-2345
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1281
Practice Address - Country:US
Practice Address - Phone:541-584-2345
Practice Address - Fax:541-584-2345
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15989207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059290Medicaid
OR930069800Medicaid
ORP00634855Medicare PIN
ORF45435Medicare UPIN
OR930069800Medicaid
OR059290Medicaid