Healthcare Provider Details

I. General information

NPI: 1124175542
Provider Name (Legal Business Name): DAVID L SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 FAYETTE RD
MEMPHIS TN
38128-5723
US

IV. Provider business mailing address

4321 FAYETTE RD
MEMPHIS TN
38128-5723
US

V. Phone/Fax

Practice location:
  • Phone: 901-386-6399
  • Fax: 901-372-2135
Mailing address:
  • Phone: 901-386-6399
  • Fax: 901-372-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number14078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: