Basic Information
| Provider Information | |||||||||
| NPI: | 1376584946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 PLEASANT AVE S | ||||||||
| Address2: | |||||||||
| City: | PARK RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564701440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187322800 | ||||||||
| FaxNumber: | 2187322857 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 PLEASANT AVE S | ||||||||
| Address2: | |||||||||
| City: | PARK RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564701440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187322800 | ||||||||
| FaxNumber: | 2187322857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31955 | MN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 17692SM | 01 | MN | MNBS # | OTHER | 5116 | 01 | MN | NDBS # | OTHER | 773383 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | 0700494 | 01 | MN | MEDICA # | OTHER | 1700585 | 01 | MN | MEDICA # | OTHER | 1M791SM | 01 | MN | MNBS # | OTHER | HP25768 | 01 | MN | HEALTHPARTNERS # | OTHER | 17691SM | 01 | MN | MNBS # | OTHER | 17693SM | 01 | MN | MNBS # | OTHER | 599388100 | 05 | MN | MEDICAID | MN200004 | 01 | MN | LHS/BANNERHEALTH # | OTHER | 1700495 | 01 | MN | MEDICA # | OTHER | DA9041015678 | 01 | MN | PREFERRED ONE # | OTHER | 108032 | 01 | MN | UCARE # | OTHER | 10476 | 01 | MN | NDBS # | OTHER | 27944SM | 01 | MN | MNBS # | OTHER |