Healthcare Provider Details

I. General information

NPI: 1154372670
Provider Name (Legal Business Name): DAVID M SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 NALL AVE STE. 200
OVERLAND PARK KS
66211-1366
US

IV. Provider business mailing address

10730 NALL AVE STE. 200
OVERLAND PARK KS
66211-1366
US

V. Phone/Fax

Practice location:
  • Phone: 913-945-9800
  • Fax: 913-945-9838
Mailing address:
  • Phone: 913-945-9800
  • Fax: 913-945-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0423020
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: