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David Allen Smith

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NPI Number Detailed Information

Provider Information:

Name: David Allen Smith
Gender: M
Provider License Number If Given: 01040403A

NPI Information:

NPI: 1962405993
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 3/31/2014

Provider Business Mailing Address:

Address: 7613 W JEFFERSON BLVD STE 200
Fort Wayne, IN 46804
Phone Number: 2604697337
Fax Number: 2604697340

Provider Business Practice Location Address:

Address: 7613 W JEFFERSON BLVD STE 200
Fort Wayne, IN 46804
Phone Number: 2604697337
Fax Number: 2604697340

Provider Taxonomy:

Primary: 208600000X
Secondary (if any): 2086S0120X
State: IN

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