=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821083379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG DOUGLAS SMITH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2005
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12222 MERIT DR SUITE 1420
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-233-6237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12222 MERIT DR STE 1420
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-233-6237
-----------------------------------------------------
Fax | 972-233-1734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | E6622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------