MEDICARE: CYNTHIA SMOOT 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	208000000X	Pediatrics Physician	L4723	TX

General Provider Information

NPI Number	:	1942201280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA SMOOT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 841969
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18350 TIMBER FOREST DR
Second Line	:	100
City	:	ATASCOCITA
State	:	TX
Zip	:	77346-2957
Country	:	US
Telephone Number	:	281-446-2196
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/21/2008

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