Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | P8416 | TX |
N | 207PP0204X | Pediatric Emergency Physician | P8416 | TX |
Y | 208000000X | Pediatrician | P8416 | TX |
NPI | 1104195379 |
---|---|
Provider Name | Mauricio Ernesto Smart |
First Address | Fort Worth, TX 76199-0213 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2011 |
Last Update Date | 30/07/2020 |