Individual
DAVID PHILLIPS SMACK
Active
Individual
DAVID PHILLIPS SMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
D0040409
MD
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
D0040409
MD
207NS0135X
Procedural Dermatology Physician
D0040409
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070010482
MC RAILROAD
MD
01
—
21D0931132
CLIA
MD
01
—
248038
MAMSI PLANS
MD
01
—
KB59TA
BLUE SHIELD
MD
01
—
W0170001
BLUE SHIELD
MD
Enumeration date
10/13/2005
Last updated
10/06/2020
Update your record
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