Individual
DAVID ALLEN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7613 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4182
(260) 469-7337
(260) 469-7340
Mailing address
7613 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4182
(260) 469-7337
(260) 469-7340
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01040403A
IN
2086S0120X
Pediatric Surgery Physician
Primary
01040403A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104683309
—
MI
05
—
200049180
—
IN
05
—
2080877
—
OH
Enumeration date
05/23/2005
Last updated
03/31/2014
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