=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881642999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD DAVID SMITH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 574 WILLIS ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06010-7267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 959-217-1500
-----------------------------------------------------
Fax | 959-217-1500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 574 WILLIS ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06010-7267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 959-217-1500
-----------------------------------------------------
Fax | 959-217-1500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0204X
-----------------------------------------------------
Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
-----------------------------------------------------
License Number | 202000
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 5689
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 11778
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 200100466
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 202000
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 2080P0204X
-----------------------------------------------------
Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
-----------------------------------------------------
License Number | 200100466
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------