Provider Demographics
NPI:1154363232
Name:SMITH, DAVID SEAN (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SEAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 SAINT JOHNS BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1563
Mailing Address - Country:US
Mailing Address - Phone:417-625-2300
Mailing Address - Fax:417-625-2005
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-625-2300
Practice Address - Fax:417-625-2005
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170263207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207790205Medicaid
OK100114210CMedicaid
KS100395140DMedicaid
OK100114210CMedicaid
MOMA2082075Medicare PIN