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Organization
SAN MARCOS DIAGNOSTICS PA
Active
Organization
SAN MARCOS DIAGNOSTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GRAYSON KEITH SMITH M.D. (PRESIDENT)
(512) 396-1525
Entity
Organization
Contact information
Practice address
1305 WONDER WORLD DR STE 206, SAN MARCOS, TX 78666-7540
(512) 396-1525
Mailing address
1305 WONDER WORLD DR STE 206, SAN MARCOS, TX 78666-7540
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032MD
BCBS
TX
05
—
170927101
—
TX
Enumeration date
10/05/2007
Last updated
11/17/2015
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