Provider Demographics
NPI:1134388226
Name:DAVID E. SMITH MD, A PROFESSIONAL CORPORATION.
Entity type:Organization
Organization Name:DAVID E. SMITH MD, A PROFESSIONAL CORPORATION.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-484-8013
Mailing Address - Street 1:830 QUAIL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-8945
Mailing Address - Country:US
Mailing Address - Phone:209-526-8038
Mailing Address - Fax:209-526-6841
Practice Address - Street 1:830 QUAIL RIDGE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-8945
Practice Address - Country:US
Practice Address - Phone:831-484-8010
Practice Address - Fax:831-484-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG196602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G196600Medicaid
CAA40715Medicare UPIN
CA00G196600Medicaid