MEDICARE: MEGAN SMITH DO

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	BP10030899	TX
2	207R00000X	Internal Medicine Physician	N8728	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01208114	OTHER		MEDICARE PTAN

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	:	1831359280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN SMITH DO

Provider Business Mailing Address
First Line	:	5232 COLLEYVILLE BLVD
Second Line	:	SUITE 100
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-7826
Country	:	US
Telephone Number	:	817-912-9920
Fax Number	:	817-498-0635

Provider Business Practice Location Address
First Line	:	5232 COLLEYVILLE BLVD
Second Line	:	SUITE 100
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-7826
Country	:	US
Telephone Number	:	817-912-9920
Fax Number	:	817-498-0635

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	10/11/2013

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Directions to “ MEGAN SMITH DO” Practice Location

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