Healthcare Provider Details

I. General information

NPI: 1568462943
Provider Name (Legal Business Name): DAVID MICHAEL SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 W. UNION HILLS DRIVE A-140
GLENDALE AZ
85308
US

IV. Provider business mailing address

6320 W. UNION HILLS DRIVE BLDG A, STE 140
GLENDALE AZ
85308-7239
US

V. Phone/Fax

Practice location:
  • Phone: 623-435-8346
  • Fax: 623-435-9346
Mailing address:
  • Phone: 623-435-8346
  • Fax: 623-435-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number3260
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: