Provider Information for 1508370198
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DAVID SHANE SMITH
Sex: Male
NPI: 1508370198
Last Updated: 2017-11-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1508370198 | ||||||||
| Enumeration Date | 2017-11-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2485 MARYVILLE DR DUBUQUE, IA 52001-1663 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 2485 MARYVILLE DR DUBUQUE, IA 52001-1663 United States Phone: 563-590-8847 | Fax: | ||||||||
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