MEDICARE: DR. RUSSELL R. SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H0828	TX

General Provider Information

NPI Number	:	1316990187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL R. SMITH MD

Provider Business Mailing Address
First Line	:	5068 W PLANO PKWY
Second Line	:	SUITE 224
City	:	PLANO
State	:	TX
Zip	:	75093-4408
Country	:	US
Telephone Number	:	972-447-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5068 W PLANO PKWY
Second Line	:	SUITE 224
City	:	PLANO
State	:	TX
Zip	:	75093-4408
Country	:	US
Telephone Number	:	972-447-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/05/2008

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