Provider Demographics
NPI:1194272245
Name:SMITH, DAVID COWLEY (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:COWLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:280 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5793
Mailing Address - Country:US
Mailing Address - Phone:801-223-4860
Mailing Address - Fax:801-371-8993
Practice Address - Street 1:280 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5793
Practice Address - Country:US
Practice Address - Phone:801-223-4860
Practice Address - Fax:801-371-8993
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT10083415-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant