Provider Demographics
NPI:1376584946
Name:SMITH, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
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 1:705 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1440
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2857
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2857
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31955208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN17692SMOtherMNBS #
MN5116OtherNDBS #
MN773383OtherAMERICA'S PPO/ARAZ #
MN0700494OtherMEDICA #
MN1700585OtherMEDICA #
MN1M791SMOtherMNBS #
MNHP25768OtherHEALTHPARTNERS #
MN17691SMOtherMNBS #
MN17693SMOtherMNBS #
MN599388100Medicaid
MNMN200004OtherLHS/BANNERHEALTH #
MN1700495OtherMEDICA #
MNDA9041015678OtherPREFERRED ONE #
MN108032OtherUCARE #
MN10476OtherNDBS #
MN27944SMOtherMNBS #
MNMN200004OtherLHS/BANNERHEALTH #
MN5116OtherNDBS #
MN0700494OtherMEDICA #
MN1700495OtherMEDICA #