Provider Demographics
NPI:1962497636
Name:SMITH, DAVID GAIL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GAIL
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 1:4510 EXECUTIVE DR., STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3054
Mailing Address - Country:US
Mailing Address - Phone:858-453-8060
Mailing Address - Fax:858-453-8260
Practice Address - Street 1:9900 GENESEE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1210
Practice Address - Country:US
Practice Address - Phone:858-453-8060
Practice Address - Fax:858-453-8260
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37087207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46948Medicare UPIN
CAG37087Medicare ID - Type Unspecified