Healthcare Provider Details

I. General information

NPI: 1396887691
Provider Name (Legal Business Name): ARCHIE DAN SMITH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 RED RIVER
AUSTIN TX
78701-1921
US

IV. Provider business mailing address

PO BOX 5692
AUSTIN TX
78763-5692
US

V. Phone/Fax

Practice location:
  • Phone: 512-479-3526
  • Fax: 512-474-2720
Mailing address:
  • Phone: 512-474-5244
  • Fax: 512-474-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberE8916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: