Provider Demographics
NPI:1245214014
Name:SMITH, DAVID HERBER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HERBER GEORGE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7571 E MARTELLA LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1317
Mailing Address - Country:US
Mailing Address - Phone:714-541-5591
Mailing Address - Fax:714-210-7087
Practice Address - Street 1:14351 MYFORD RD
Practice Address - Street 2:SUITE B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7045
Practice Address - Country:US
Practice Address - Phone:714-550-9990
Practice Address - Fax:714-550-1226
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA51316173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF81893Medicare UPIN