Provider Demographics
NPI:1558840322
Name:SMITH, DONOVAN ANDREW
Entity Type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR STE 2W203
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5761
Mailing Address - Country:US
Mailing Address - Phone:760-323-4272
Mailing Address - Fax:
Practice Address - Street 1:555 E TACHEVAH DR STE 2W203
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5761
Practice Address - Country:US
Practice Address - Phone:760-323-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant