Healthcare Provider Details

I. General information

NPI: 1255224283
Provider Name (Legal Business Name): CARSON KEITH SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1173
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1173
US

V. Phone/Fax

Practice location:
  • Phone: 409-266-7856
  • Fax: 409-772-1224
Mailing address:
  • Phone: 409-266-7856
  • Fax: 409-772-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10094027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: