Provider Demographics
NPI:1609839364
Name:SMITH, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
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 1:901 N FISK AVE
Mailing Address - Street 2:#224
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-8236
Mailing Address - Country:US
Mailing Address - Phone:325-641-8839
Mailing Address - Fax:325-646-6676
Practice Address - Street 1:901 N FISK AVE
Practice Address - Street 2:#224
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-8236
Practice Address - Country:US
Practice Address - Phone:325-641-8839
Practice Address - Fax:325-646-6676
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9812207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029797001Medicaid
TX029797001Medicaid
TX00207LMedicare PIN