Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R0135 | TX |
N | 111NI0900X | Internist | R0135 | TX |
Y | 207RR0500X | Rheumatology | R0135 | TX |
NPI | 1053687970 |
---|---|
Provider Name | Holly Bentz Smith |
First Address | Shenandoah, TX 77385-3314 |
Second Address | Shenandoah, TX 77385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2012 |
Last Update Date | 02/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP10046699 | TEXAS STATE BOARD (01) | TX |