Provider Demographics
NPI:1609828516
Name:SMITH, DAVID M (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 N WALDROP DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4705
Mailing Address - Country:US
Mailing Address - Phone:817-701-4253
Mailing Address - Fax:817-701-4258
Practice Address - Street 1:1001 N WALDROP DR
Practice Address - Street 2:SUITE 403
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4705
Practice Address - Country:US
Practice Address - Phone:817-701-4253
Practice Address - Fax:817-701-4258
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03617363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N3817OtherBCBS OF TEXAS
TX8N3817OtherBCBS OF TEXAS
TXP84428Medicare UPIN
TX970031065Medicare PIN