Healthcare Provider Details

I. General information

NPI: 1679548762
Provider Name (Legal Business Name): ANTHONY SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CAMDEN ST SUITE 208
SAN ANTONIO TX
78215-2012
US

IV. Provider business mailing address

311 CAMDEN ST SUITE 208
SAN ANTONIO TX
78215-2012
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-0228
  • Fax: 210-455-0169
Mailing address:
  • Phone: 210-829-0228
  • Fax: 210-455-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG3794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: