Healthcare Provider Details

I. General information

NPI: 1164578845
Provider Name (Legal Business Name): REGINALD LINDSEY SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR
JBSA SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

7510 LINCOLN VILLAGE DR
SAN ANTONIO TX
78244-1517
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4141
  • Fax:
Mailing address:
  • Phone: 210-661-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: