1689732042 NPI number — DR. LARRY LAMAR SMITH MD

Table of content: DR. LARRY LAMAR SMITH MD (NPI 1689732042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689732042 NPI number — DR. LARRY LAMAR SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LARRY
Provider Middle Name:
LAMAR
Provider Name Prefix Text:
DR.
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:
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:
1689732042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILMER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75644-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-758-3376
Provider Business Mailing Address Fax Number:
903-758-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6757 US HIGHWAY 271 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75644-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-758-3376
Provider Business Practice Location Address Fax Number:
903-758-3526
Provider Enumeration Date:
12/05/2006

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: 207N00000X , with the licence number:  G7887 , 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: 070001243 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 033578801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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