Healthcare Provider Details

I. General information

NPI: 1437203429
Provider Name (Legal Business Name): PATRICK HUNTER SMOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N PIEDRAS ST WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN. CREDENTIALS
EL PASO TX
79920-5001
US

IV. Provider business mailing address

5005 N PIEDRAS ST WILLIAM BEAUMONT ARMY MEDICAL CENTER, ATTN CREDENTIA
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-569-2107
  • Fax: 915-569-1233
Mailing address:
  • Phone: 915-569-2107
  • Fax: 915-569-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2015021378
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17977
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number61668
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: