Individual
DANIEL ROBERT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 WHITNEY CT, CENTRA CARE CLINIC, ST CLOUD, MN 56303-1899
(320) 251-1755
(507) 434-1477
Mailing address
1520 WHITNEY CT, CENTRA CARE CLINIC, ST CLOUD, MN 56303-1899
(320) 251-1755
(507) 434-1477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41725
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080140250
MEDICARE RAILROAD
MN
05
—
340757800
—
MN
Enumeration date
12/12/2005
Last updated
03/07/2012
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