Provider Demographics
NPI:1952387169
Name:SMITH, DANIEL LEE (D O)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODLAKE TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8113
Mailing Address - Country:US
Mailing Address - Phone:740-397-3647
Mailing Address - Fax:740-397-0908
Practice Address - Street 1:11 WOODLAKE TRL
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8113
Practice Address - Country:US
Practice Address - Phone:740-397-3647
Practice Address - Fax:740-397-0908
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE00627Medicare UPIN