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General NPI Number Information
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NPI Number | 1275758047
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Entity Type | Individual
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Provider Name | STEPHEN LYNN SMITH D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 798 BEAR CREEK RD
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-7283
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Country | US
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Telephone | 830-990-8200
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Fax | 830-990-8200
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Provider Business Mailing Address
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Address Line | 798 BEAR CREEK RD
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-7283
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Country | US
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Telephone | 830-990-8200
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Fax | 830-990-8200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | G8426
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License Number State | TX
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