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NPI Code Detail

MEDICARE: DANIEL BURTION SMITH M.D.

MEDICARE: DANIEL BURTION 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
1207Q00000XFamily Medicine Physician036070695IL

Other Identifiers

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

General Provider Information

NPI Number : 1699779538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL BURTION SMITH M.D.
Provider Business Mailing Address
First Line : 1200 N STATE HIGHWAY 121
Second Line :
City : MT ZION
State : IL
Zip : 62549-1224
Country : US
Telephone Number : 217-864-5531
Fax Number : 217-864-2449
Provider Business Practice Location Address
First Line : 4965 E LOST BRIDGE RD
Second Line :
City : DECATUR
State : IL
Zip : 62521-5139
Country : US
Telephone Number : 217-864-5531
Fax Number : 217-864-2449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 12/30/2021

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Directions to “ DANIEL BURTION SMITH M.D.” Practice Location

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