MEDICARE: DR. NATHAN RYAN SMALLWOOD 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	207P00000X	Emergency Medicine Physician	Q3108	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208C00000X	Colon & Rectal Surgery Physician	Q3108	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609019934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN RYAN SMALLWOOD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35629
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0629
Country	:	US
Telephone Number	:	214-424-2213
Fax Number	:	214-231-2159

Provider Business Practice Location Address
First Line	:	425 N HIGHLAND AVE STE 130
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-7383
Country	:	US
Telephone Number	:	903-892-9179
Fax Number	:	903-868-2317

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

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/12/2021

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Directions to “ DR. NATHAN RYAN SMALLWOOD M.D.” Practice Location

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