Healthcare Provider Details

I. General information

NPI: 1245927102
Provider Name (Legal Business Name): SETH BORNE-SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 82ND ST
LUBBOCK TX
79423-2065
US

IV. Provider business mailing address

9710 REMINGTON AVE
LUBBOCK TX
79424-7073
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-7800
  • Fax: 806-743-7651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW1387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: