Healthcare Provider Details

I. General information

NPI: 1245214014
Provider Name (Legal Business Name): DAVID HERBER GEORGE SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14351 MYFORD RD SUITE B
TUSTIN CA
92780-7045
US

IV. Provider business mailing address

7571 E MARTELLA LN
ANAHEIM CA
92808-1317
US

V. Phone/Fax

Practice location:
  • Phone: 714-550-9990
  • Fax: 714-550-1226
Mailing address:
  • Phone: 714-541-5591
  • Fax: 714-210-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA51316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: