Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | M3741 | TX |
NPI | 1033138102 |
---|---|
Provider Name | Dr. Eric Bryan Smith |
First Address | Dallas, TX 75246-1800 |
Second Address | Dallas, TX 75246-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 07/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187108601 | (05) | TX |
I70750 | (02) | TX |
P00476750 | RR MEDICARE (01) | TX |