Healthcare Provider Details

I. General information

NPI: 1467774604
Provider Name (Legal Business Name): PHILIP O SMITH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 TRAVIS ST SUITE 210
DALLAS TX
75204-1448
US

IV. Provider business mailing address

3535 TRAVIS ST SUITE 210
DALLAS TX
75204-1448
US

V. Phone/Fax

Practice location:
  • Phone: 214-522-0210
  • Fax: 214-522-0474
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberF7180
License Number StateTX

VIII. Authorized Official

Name: DR. PHILIP O SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-522-0210