Individual
MARK B SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 BARBARA JORDAN BLVD, SUITE 400, SAN ANTONIO, TX 78723-3078
(512) 708-1234
(512) 708-4567
Mailing address
1301 BARBARA JORDAN BLVD, STE 400, AUSTIN, TX 78723-3078
(512) 708-1234
(512) 708-4567
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H1021
TX
2086S0120X
Pediatric Surgery Physician
H1021
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112887801
—
TX
05
—
139781201
—
TX
Enumeration date
05/31/2005
Last updated
10/08/2008
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