MEDICARE: KRISTIN BUSSEY-SMITH MD PA

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	207K00000X	Allergy & Immunology Physician	M5080	TX
2	207RR0500X	Rheumatology Physician	M5080	TX
3	207KA0200X	Allergy Physician	M5080	TX
4	207R00000X	Internal Medicine Physician	M5080	TX
5	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	M5080	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

General Provider Information

NPI Number	:	1922128172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIN BUSSEY-SMITH MD PA

Provider Business Mailing Address
First Line	:	19260 STONE OAK PKWY
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3365
Country	:	US
Telephone Number	:	210-495-4335
Fax Number	:	210-587-7415

Provider Business Practice Location Address
First Line	:	19260 STONE OAK PKWY
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3365
Country	:	US
Telephone Number	:	210-495-4335
Fax Number	:	210-587-7415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KRISTIN LOUISE BUSSEY-SMITH
Credential	:	M.D.
Telephone Number	:	210-495-4335

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	05/04/2009

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