=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477866721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN R SMYER MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2010
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4213 85TH ST SUITE B
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79423-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-368-9631
-----------------------------------------------------
Fax | 806-368-9633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10210 FRANKFORD AVE STE 310
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-368-9631
-----------------------------------------------------
Fax | 806-368-9633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN ROBERT SMYER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-368-9631
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------