Healthcare Provider Details

I. General information

NPI: 1316961618
Provider Name (Legal Business Name): DAVID SMIRNOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

2610 TRUMAN CREEK RD
KILA MT
59920
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-1789
  • Fax: 406-751-5776
Mailing address:
  • Phone: 406-756-6982
  • Fax: 406-751-5776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9847
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberMED-PHYS-LIC-9847
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMED-PHYS-LIC-9847
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: