Provider Demographics
NPI:1912990888
Name:SMITH, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
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 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0164
Mailing Address - Fax:850-216-0180
Practice Address - Street 1:1300 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-216-0191
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55402207RC0000X
GA027668207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000Other1ST MEDICAL NETWORK
FL00000OtherBCBS
FL00000OtherUNITED HEATLH CARE
AL009978990Medicaid
FL00000OtherFOCUS
FL00000OtherSOUTH CARE
GA0041756Medicaid
FL061335500Medicaid
FL00000OtherBEECH STREET/CAPP CARE
FL00000OtherHUMANA/CHOICE CARE
FL00000OtherCOMPHRENSIVE HEALTH CARE
FL00000OtherVISTA
FL01280OtherUNIVERSAL HEALTH CARE
FL00000OtherUNITED HEATLH CARE
FLE22520Medicare UPIN