Basic Information
| Provider Information | |||||||||
| NPI: | 1912990888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502160164 | ||||||||
| FaxNumber: | 8502160180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502160100 | ||||||||
| FaxNumber: | 8502160191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 01/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME55402 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 027668 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00000 | 01 | FL | 1ST MEDICAL NETWORK | OTHER | 00000 | 01 | FL | BCBS | OTHER | 00000 | 01 | FL | UNITED HEATLH CARE | OTHER | 009978990 | 05 | AL | MEDICAID | 00000 | 01 | FL | FOCUS | OTHER | 00000 | 01 | FL | SOUTH CARE | OTHER | 0041756 | 05 | GA | MEDICAID | 061335500 | 05 | FL | MEDICAID | 00000 | 01 | FL | BEECH STREET/CAPP CARE | OTHER | 00000 | 01 | FL | HUMANA/CHOICE CARE | OTHER | 00000 | 01 | FL | COMPHRENSIVE HEALTH CARE | OTHER | 00000 | 01 | FL | VISTA | OTHER | 01280 | 01 | FL | UNIVERSAL HEALTH CARE | OTHER |