MEDICARE: STEPHANIE SMITH 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	L8196	TX

General Provider Information

NPI Number	:	1609853639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SMITH MD

Provider Business Mailing Address
First Line	:	PO BOX 4767
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4767
Country	:	US
Telephone Number	:	713-526-5511
Fax Number	:	713-520-4755

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 1700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2329
Country	:	US
Telephone Number	:	713-526-5511
Fax Number	:	713-520-4705

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	11/25/2009

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