MEDICARE: DR. STEVEN LANNY 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	207R00000X	Internal Medicine Physician	H8415	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00765702	OTHER	TX	RAILROAD MEDICARE

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8H3658	OTHER	TX	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1598847949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN LANNY SMITH M.D.

Provider Business Mailing Address
First Line	:	6108 OAKBEND TRL
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3917
Country	:	US
Telephone Number	:	817-989-9529
Fax Number	:	682-730-2009

Provider Business Practice Location Address
First Line	:	6108 OAKBEND TRL
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3917
Country	:	US
Telephone Number	:	817-989-9529
Fax Number	:	682-730-2009

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/27/2016

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Directions to “ DR. STEVEN LANNY SMITH M.D.” Practice Location

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