MEDICARE: DR. THERESA 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	207V00000X	Obstetrics & Gynecology Physician	V0875	TX

General Provider Information

NPI Number	:	1932723566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA SMITH MD

Provider Business Mailing Address
First Line	:	9398 VISCOUNT BLVD STE 2B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-8072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9398 VISCOUNT BLVD STE 2B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-8072
Country	:	US
Telephone Number	:	915-629-0442
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	01/23/2025

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