Individual
DANIEL BURTION SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4965 E LOST BRIDGE RD, DECATUR, IL 62521-5139
(217) 864-5531
(217) 864-2449
Mailing address
1200 N STATE HIGHWAY 121, MT ZION, IL 62549-1224
(217) 864-5531
(217) 864-2449
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036070695
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360706951
—
IL
Enumeration date
06/09/2005
Last updated
12/30/2021
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