Provider Demographics
NPI:1417947755
Name:SMITHSON, DAVID GERARD (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GERARD
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:GERARD
Other - Last Name:SMITHSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PC
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-943-4554
Mailing Address - Fax:816-943-4654
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-943-4554
Practice Address - Fax:816-943-4654
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8N64208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18578OtherBNDD
KS100120320BMedicaid
MO2076744Medicaid
MO1417947755OtherNPI#
KS0423432OtherSTATE LICENSE
MOR8N64OtherSTATE LICENSE
KS0423432OtherSTATE LICENSE
MOR8N64OtherSTATE LICENSE
E22614Medicare UPIN
MOP58212Medicare ID - Type Unspecified