Smith, David R
Smith, David R is an individual health care provider with primary practice located at 2636 Eastern Ave , Plymouth WI 53073. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Occupational Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Smith, David R can be contacted via phone (920) 893-4010.Contact Information
Primary practice address
2636 Eastern Ave
Plymouth WI 53073
Phone: (920) 893-4010
Fax: (920) 459-1163
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 31779-020 | Wisconsin |
| Allopathic & Osteopathic Physicians / Occupational Medicine | 2083X0100X | 31779-020 | Wisconsin |
Profile Details
| NPI number | 1902913114 |
|---|---|
| LBN Legal business name | Smith, David R |
| Credentials | MD, MPH |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2006 |
| Last updated | Mar 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902913114 | NPPES |
| Wisconsin | MEDICAID | 31659900 |
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