Provider Demographics
NPI:1316961618
Name:SMIRNOW, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SMIRNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 TRUMAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILA
Mailing Address - State:MT
Mailing Address - Zip Code:59920
Mailing Address - Country:US
Mailing Address - Phone:406-756-6982
Mailing Address - Fax:406-751-5776
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-752-1789
Practice Address - Fax:406-751-5776
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9847174400000X
MTMED-PHYS-LIC-9847207ZC0006X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTG50873Medicare UPIN