Healthcare Provider Details

I. General information

NPI: 1912992843
Provider Name (Legal Business Name): DANIEL F SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 W 43RD AVE
PINE BLUFF AR
71603-7010
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR. SUITE 690
LITTLE ROCK AR
72205-6328
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-7477
  • Fax: 870-535-4121
Mailing address:
  • Phone: 501-227-8422
  • Fax: 501-537-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberL1754
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE1486
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: