Provider Demographics
NPI:1235180258
Name:SMITH, DAVID KIMBALL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KIMBALL
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 1:1306 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5061
Mailing Address - Country:US
Mailing Address - Phone:407-682-1525
Mailing Address - Fax:
Practice Address - Street 1:1306 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5061
Practice Address - Country:US
Practice Address - Phone:407-682-1525
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist