Provider Demographics
NPI:1710948799
Name:SMITH, DAVID MATTHEW BEAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW BEAMAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MB
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2100 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2274
Mailing Address - Country:US
Mailing Address - Phone:307-856-4161
Mailing Address - Fax:307-857-5212
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7000
Practice Address - Fax:828-586-7467
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145192207Q00000X, 208M00000X
AZ37797207Q00000X
ORMD153356207Q00000X, 208M00000X
WY10922A207Q00000X, 208M00000X
NC200400752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500632858Medicaid
ORR169568Medicare PIN
I17127Medicare UPIN