Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP10038781 | TX |
N | 207Q00000X | Family Doctor | P3453 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | P3453 | TX |
NPI | 1275854622 |
---|---|
Provider Name | Debbie Villarreal Smith |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 22/04/2017 |