Healthcare Provider Details

I. General information

NPI: 1023696788
Provider Name (Legal Business Name): WES EZRA SMOOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILBERT EARL SMOOT II

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6522
  • Fax:
Mailing address:
  • Phone: 410-328-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0101060
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: