Healthcare Provider Details

I. General information

NPI: 1073959912
Provider Name (Legal Business Name): PATRICK BENNETT SMOLLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY STE 570
AUSTIN TX
78705-1024
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-2554
  • Fax: 512-454-2824
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10046712
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberR1456
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR1456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: