Healthcare Provider Details

I. General information

NPI: 1083845747
Provider Name (Legal Business Name): NATHAN MICHAEL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 8TH AVE STE 305
FORT WORTH TX
76104-4140
US

IV. Provider business mailing address

1307 8TH AVE STE 305
FORT WORTH TX
76104-4140
US

V. Phone/Fax

Practice location:
  • Phone: 817-912-8000
  • Fax: 817-912-8010
Mailing address:
  • Phone: 817-912-8000
  • Fax: 817-912-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN1898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: