David M Tully Smith M D a Medical Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G30229 Issued in CA

Legal business name

DAVID M TULLY SMITH M D A MEDICAL CORPORATION

Practice address

711 D St
Suite 111
San Rafael, CA 94901-3707

Phone

(415) 453-3030

NPI assigned

Feb 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dana Tully-Smith

Title

Vice President

Phone

(707) 544-2632

Specialties & licenses 1

Addresses

Other names 1

• Mill Valley Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Michael Tully-Smith, M.D.

  • Family Medicine Physician
  • San Rafael, CA
  • NPI 1598890287
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226016000000",
    "number": "1780728246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3137",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949273137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 D ST",
            "address_2": "SUITE 111",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013707",
            "telephone_number": "415-453-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID M TULLY SMITH M D A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-17",
        "last_updated": "2008-11-07",
        "status": "A",
        "authorized_official_last_name": "TULLY-SMITH",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "707-544-2632",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G30229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mill Valley Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kacy Catherine Dapp
• Megan Dardis
• Casey Allen Darmawan
• Darron R Rishwain DDS Inc
• Jennifer Daughrity
• David Talamo, MFT
• John E. David, MD
• Douglas Peter Davidson Jr., PA
• Geeta Ann Davidson, M.S.
• Natalie Fay Davidson, MFT

• Family Medicine Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.