Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | H5069 | TX |
NPI | 1093767865 |
---|---|
Provider Name | Dr. David C Smith |
First Address | Granbury, TX 76048-8559 |
Second Address | Fort Worth, TX 76104-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097299401 | (05) | TX |
D79998 | (02) | TX |