Healthcare Provider Details

I. General information

NPI: 1861526741
Provider Name (Legal Business Name): CYNTHIA L SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6247 WOODLAND DR
DALLAS TX
75225-2838
US

IV. Provider business mailing address

6247 WOODLAND DR
DALLAS TX
75225-2838
US

V. Phone/Fax

Practice location:
  • Phone: 800-859-9269
  • Fax: 337-332-6071
Mailing address:
  • Phone: 800-859-9269
  • Fax: 337-332-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberK2594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: