1457303323 NPI number — MR. MATTHEW T SMITH M.D.

Table of content: MR. MATTHEW T SMITH M.D. (NPI 1457303323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457303323 NPI number — MR. MATTHEW T SMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MATTHEW
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457303323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 COLORADO BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-6884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-219-0558
Provider Business Mailing Address Fax Number:
940-320-1708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4333 N JOSEY LN
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75010-4629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-557-9627
Provider Business Practice Location Address Fax Number:
214-731-0050
Provider Enumeration Date:
05/17/2006

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: 207RN0300X , with the licence number:  MD072037L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: N3316 , 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: 207294401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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