MEDICARE: KEELY G SMITH M.D.

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	207RP1001X	Pulmonary Disease Physician	M1353	TX
2	2080P0214X	Pediatric Pulmonology Physician	M1353	TX
3	208M00000X	Hospitalist Physician	M1353	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	173516903	OTHER	TX	CSHCN
3	8W7643	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326192576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEELY G SMITH M.D.

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	JJL 205J
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-500-5586
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-704-4000
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	04/01/2024

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Directions to “ KEELY G SMITH M.D.” Practice Location

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