MEDICARE: CHRISTINE ELIZABETH SMITH

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	363A00000X	Physician Assistant	PA12141	TX

General Provider Information

NPI Number	:	1386117125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ELIZABETH SMITH

Provider Business Mailing Address
First Line	:	5184 TEX OAK AVE FL 4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7822
Country	:	US
Telephone Number	:	214-266-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	8134 TEX OAK AVENUE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235
Country	:	US
Telephone Number	:	214-590-8000
Fax Number	:

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	08/28/2019

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