Provider Demographics
NPI:1184765943
Name:SMITH, DAVID DUANE (PHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DUANE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4625 BECKLEY RD
Mailing Address - Street 2:BUILDING 300
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7948
Mailing Address - Country:US
Mailing Address - Phone:269-223-7642
Mailing Address - Fax:269-979-4163
Practice Address - Street 1:4625 BECKLEY ROAD
Practice Address - Street 2:BUILDING 300
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4463
Practice Address - Country:US
Practice Address - Phone:269-223-7642
Practice Address - Fax:269-979-4163
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI6301006459103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5990003Medicare ID - Type Unspecified