Provider Demographics
NPI:1568462943
Name:SMITH, DAVID MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
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 1:6320 W. UNION HILLS DRIVE
Mailing Address - Street 2:BLDG A, STE 140
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7239
Mailing Address - Country:US
Mailing Address - Phone:623-435-8346
Mailing Address - Fax:623-435-9346
Practice Address - Street 1:6320 W. UNION HILLS DRIVE
Practice Address - Street 2:A-140
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-435-8346
Practice Address - Fax:623-435-9346
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391053Medicaid
AZ391053Medicaid
AZ62185Medicare ID - Type Unspecified
AZ39105304Medicaid
AZZ109769Medicare PIN
AZ391053Medicaid
AZ109769Medicare PIN