1376535542 NPI number — FRANK A SMITH MD

Table of content: FRANK A SMITH MD (NPI 1376535542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376535542 NPI number — FRANK A SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
FRANK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
FRANK
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376535542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROCKETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75835-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-544-2157
Provider Business Mailing Address Fax Number:
936-544-5572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 E LOOP 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROCKETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75835-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-544-2157
Provider Business Practice Location Address Fax Number:
936-544-5572
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D7878 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 089910602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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