Healthcare Provider Details

I. General information

NPI: 1427097229
Provider Name (Legal Business Name): DAVID A. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N DOUTY ST EMERGENCY DEPARTMENT
HANFORD CA
93230-3722
US

IV. Provider business mailing address

4551 GLENCOE AVE SUITE 260
MARINA DEL REY CA
90292-6385
US

V. Phone/Fax

Practice location:
  • Phone: 559-583-2100
  • Fax:
Mailing address:
  • Phone: 310-301-2030
  • Fax: 310-306-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG70778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: