Healthcare Provider Details

I. General information

NPI: 1093767865
Provider Name (Legal Business Name): DAVID C SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 8TH AVE STE 1
FORT WORTH TX
76104-2522
US

IV. Provider business mailing address

PO BOX 1559
GRANBURY TX
76048-8559
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-9957
  • Fax: 817-336-3130
Mailing address:
  • Phone: 817-332-9957
  • Fax: 817-336-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberH5069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: