MEDICARE: DR. HARRY CHARLES 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	208000000X	Pediatrics Physician	10360R	LA

General Provider Information

NPI Number	:	1710204607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY CHARLES SMITH MD

Provider Business Mailing Address
First Line	:	25106 ARCANE CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-2958
Country	:	US
Telephone Number	:	832-559-7455
Fax Number	:	832-559-7455

Provider Business Practice Location Address
First Line	:	1 GALLERIA BLVD
Second Line	:	SUITE 1122
City	:	METAIRIE
State	:	LA
Zip	:	70001-2082
Country	:	US
Telephone Number	:	504-621-0720
Fax Number	:	504-621-0720

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

Provider Enumeration Date	:	05/01/2010
Last Update Date	:	05/01/2010

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