Provider Demographics
NPI:1811930357
Name:SMITH, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3703 CAMINO DEL RIO S
Mailing Address - Street 2:210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4031
Mailing Address - Country:US
Mailing Address - Phone:619-640-5555
Mailing Address - Fax:619-640-5550
Practice Address - Street 1:3703 CAMINO DEL RIO S
Practice Address - Street 2:210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4031
Practice Address - Country:US
Practice Address - Phone:619-640-5555
Practice Address - Fax:619-640-5550
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAGG599Z2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G667770Medicaid
CAGG604AMedicare PIN
CAG66777Medicare ID - Type Unspecified
CAGG599ZMedicare PIN
CA00G667770Medicaid