MEDICARE: DR. ANDREW BUCHANAN SMALL III 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	208D00000X	General Practice Physician	D6175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D6175	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1902938491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW BUCHANAN SMALL III M.D.

Provider Business Mailing Address
First Line	:	4118 SHENANDOAH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-2022
Country	:	US
Telephone Number	:	817-394-1011
Fax Number	:	817-394-1017

Provider Business Practice Location Address
First Line	:	2420 E RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6335
Country	:	US
Telephone Number	:	817-394-1011
Fax Number	:	817-394-1017

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

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	04/05/2026

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