Provider Demographics
NPI:1821744335
Name:SMITH, ANDREW DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6008 MAPLE AVE APT 344
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6580
Mailing Address - Country:US
Mailing Address - Phone:214-455-0251
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant