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NPI Code Detail

MEDICARE: DANIEL JACOB SMITH DO

MEDICARE: DANIEL JACOB SMITH DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianW0735TX

General Provider Information

NPI Number : 1871296335
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL JACOB SMITH DO
Provider Business Mailing Address
First Line : 984 PATTERSON ST
Second Line :
City : HOUSTON
State : TX
Zip : 77007-5423
Country : US
Telephone Number : 936-827-1915
Fax Number :
Provider Business Practice Location Address
First Line : 1301 PENNSYLVANIA AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2122
Country : US
Telephone Number : 817-250-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 06/03/2026

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