MEDICARE: DR. DAVID R. SMITH

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	207L00000X	Anesthesiology Physician	216428	NY

General Provider Information

NPI Number	:	1215909312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R. SMITH

Provider Business Mailing Address
First Line	:	445 FACTORY ST
Second Line	:	PO BOX 91
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2729
Country	:	US
Telephone Number	:	315-782-4207
Fax Number	:	315-782-8699

Provider Business Practice Location Address
First Line	:	830 WASHINGTON ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4034
Country	:	US
Telephone Number	:	315-785-4313
Fax Number	:	315-779-5114

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/05/2008

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Directions to “ DR. DAVID R. SMITH ” Practice Location

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