Healthcare Provider Details

I. General information

NPI: 1376535542
Provider Name (Legal Business Name): FRANK A SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FRANK A SMITH MD

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 E LOOP 304
CROCKETT TX
75835-1810
US

IV. Provider business mailing address

PO BOX 1189
CROCKETT TX
75835-1189
US

V. Phone/Fax

Practice location:
  • Phone: 936-544-2157
  • Fax: 936-544-5572
Mailing address:
  • Phone: 936-544-2157
  • Fax: 936-544-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD7878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: