MEDICARE: DR. ROBERT CHARLES SMITH JR. 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	207N00000X	Dermatology Physician	J4529	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

General Provider Information

NPI Number	:	1548244429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES SMITH JR. MD

Provider Business Mailing Address
First Line	:	209 N BONNIE BRAE ST
Second Line	:	SUITE 205
City	:	DENTON
State	:	TX
Zip	:	76201-3708
Country	:	US
Telephone Number	:	940-382-1718
Fax Number	:	940-380-9222

Provider Business Practice Location Address
First Line	:	209 N BONNIE BRAE ST
Second Line	:	SUITE 205
City	:	DENTON
State	:	TX
Zip	:	76201-3708
Country	:	US
Telephone Number	:	940-382-1718
Fax Number	:	940-380-9222

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

Provider Enumeration Date	:	12/03/2005
Last Update Date	:	11/01/2012

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