Healthcare Provider Details

I. General information

NPI: 1770585176
Provider Name (Legal Business Name): PAUL HEERMANS SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

IV. Provider business mailing address

6402 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-5392
  • Fax: 210-824-3986
Mailing address:
  • Phone: 210-824-5392
  • Fax: 210-824-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG7003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: