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NPI Code Detail

MEDICARE: CHARLES SMITH PHD.

MEDICARE: CHARLES SMITH PHD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist22499TX

General Provider Information

NPI Number : 1063445807
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES SMITH PHD.
Provider Business Mailing Address
First Line : 1630 S BROWNLEE BLVD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78404-3134
Country : US
Telephone Number : 361-886-6900
Fax Number : 361-888-8358
Provider Business Practice Location Address
First Line : 3733 S PORT AVE
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-4532
Country : US
Telephone Number : 361-886-6900
Fax Number : 361-888-8358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/09/2007

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