MEDICARE: MR. DAVID R SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0068056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013902857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID R SMITH MD

Provider Business Mailing Address
First Line	:	321 S FAIRFIELD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-4990
Country	:	US
Telephone Number	:	850-458-4200
Fax Number	:	850-456-7222

Provider Business Practice Location Address
First Line	:	321 S FAIRFIELD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-1412
Country	:	US
Telephone Number	:	850-458-4200
Fax Number	:	850-456-7222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	11/29/2012

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Directions to “ MR. DAVID R SMITH MD” Practice Location

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