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General NPI Number Information
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NPI Number | 1861289704
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Entity Type | Organization
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Legal Business Name | DR SMRITI PRASAD MD MPH
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 4120 SAN ANTONIO STREET
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City | ODESSA
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State | TX
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Zip | 79765
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Country | US
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Telephone | 432-894-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 SAN ANTONIO
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City | ODESSA
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State | TX
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Zip | 79765
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Country | US
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Telephone | 432-333-9200
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Fax | 432-333-9300
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. SMRITI PRASAD
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Credential | MD MPH
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Telephone | 432-333-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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