Provider Demographics
NPI:1184346280
Name:SMITH, SAMUEL DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 FORD ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2345
Mailing Address - Country:US
Mailing Address - Phone:830-953-1700
Mailing Address - Fax:830-953-1717
Practice Address - Street 1:904 FORD ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2345
Practice Address - Country:US
Practice Address - Phone:830-953-1700
Practice Address - Fax:830-953-1717
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant