MEDICARE: DR. DANNY R SMART MD

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
1	207R00000X	Internal Medicine Physician	G5622	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00075702	OTHER	TX	PALMETTO RAILROAD MCARE
2	8K0090	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174530513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY R SMART MD

Provider Business Mailing Address
First Line	:	1651 ROCK PRAIRIE RD
Second Line	:	STE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8652
Country	:	US
Telephone Number	:	979-680-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 ROCK PRAIRIE RD
Second Line	:	STE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8652
Country	:	US
Telephone Number	:	979-680-0361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	12/23/2011

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