1821434713 NPI number — MICKEY LEE SMITH M.D.

Table of content: MICKEY LEE SMITH M.D. (NPI 1821434713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821434713 NPI number — MICKEY LEE SMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MICKEY
Provider Middle Name:
LEE
Provider Name Prefix Text:
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:
1821434713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17189 IH 45 SOUTH
Provider Second Line Business Mailing Address:
MEDICAL OFFICE BUILDING 2, SUITE 675
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-270-3905
Provider Business Mailing Address Fax Number:
936-271-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17189 IH 45 SOUTH
Provider Second Line Business Practice Location Address:
MOB 2, SUITE 675
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-270-3905
Provider Business Practice Location Address Fax Number:
936-271-2410
Provider Enumeration Date:
05/17/2013

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: S7348 , 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)





Copyright © 2007-2026 www.npivalidator.com