Provider Demographics
NPI:1578574182
Name:SMITH, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3590 WEST 9000 SOUTH
Mailing Address - Street 2:#120
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-352-8373
Mailing Address - Fax:801-352-8459
Practice Address - Street 1:3590 WEST 9000 SOUTH
Practice Address - Street 2:#120
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-352-8373
Practice Address - Fax:801-352-8459
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
UT175492-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27812Medicare UPIN