MEDICARE: DR. DAVID C SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0127X	Trauma Surgery Physician	H5069	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093767865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID C SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-8559
Country	:	US
Telephone Number	:	817-332-9957
Fax Number	:	817-336-3130

Provider Business Practice Location Address
First Line	:	757 8TH AVE STE 1
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	817-332-9957
Fax Number	:	817-336-3130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/31/2020

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