Healthcare Provider Details

I. General information

NPI: 1235112004
Provider Name (Legal Business Name): DAVID BRIAN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-8261
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-871-8261
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01036527
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: