Healthcare Provider Details

I. General information

NPI: 1609828516
Provider Name (Legal Business Name): DAVID M SMITH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N WALDROP DR SUITE 403
ARLINGTON TX
76012-4705
US

IV. Provider business mailing address

1001 N WALDROP DR SUITE 403
ARLINGTON TX
76012-4705
US

V. Phone/Fax

Practice location:
  • Phone: 817-701-4253
  • Fax: 817-701-4258
Mailing address:
  • Phone: 817-701-4253
  • Fax: 817-701-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA03617
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: