Provider Demographics
NPI:1104874627
Name:SMITH, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:# L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-363-9021
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:6 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1047
Practice Address - Country:US
Practice Address - Phone:740-363-3230
Practice Address - Fax:740-368-7185
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350601885207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0751002OtherPALMETTO MEDICARE
180018458OtherTRAVELERS MEDICARE
650180OtherAETNA
OH000000118426OtherANTHEM
353077OtherSUBMITTER NO
0800476OtherUHC
OH0974549Medicaid
0751002OtherPALMETTO MEDICARE
0800476OtherUHC
180018458OtherTRAVELERS MEDICARE
E85511Medicare UPIN
OH0974549Medicaid
311098079OtherCIGNA