Healthcare Provider Details

I. General information

NPI: 1720031966
Provider Name (Legal Business Name): DANIEL CRAIG SMYRSKI PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD SUITE 200
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD SUITE 200
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5600
  • Fax: 919-863-6821
Mailing address:
  • Phone: 919-781-5600
  • Fax: 919-863-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number104057
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: