Individual
DAVID RUSSELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2509 RICHARDSON DR STE A, REIDSVILLE, NC 27320-5926
(336) 347-7998
Mailing address
5400 ENDRICK CT, GREENSBORO, NC 27409-9564
(919) 616-5704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00863
NC
363AS0400X
Surgical Physician Assistant
0010-00863
NC
363AS0400X
Surgical Physician Assistant
2006017175
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0600090
UNITED HEALTHCARE
MO
01
—
209151
ANTHEM BLUE CROSS/SHIELD
MO
01
—
2561566
COX HEALTH
MO
05
—
502277007
—
MO
Enumeration date
05/30/2006
Last updated
06/14/2022
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