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Individual

DR. CLINTON CHARLES SMITHSON III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4262
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
BP10050385
TX
207P00000X
Emergency Medicine Physician
Primary
Q5722
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
362583206
TX
05
362583207
TX
01
525037YS6P
MEDICARE
TX
01
525037YS6V
MEDICARE
TX
01
75-0818167-015
TRICARE
TX
01
75-0818167-044
TRICARE
TX
01
75-0818167-048
TRICARE
TX
01
75-0818167-051
TRICARE
TX
01
75-1976930-005
TRICARE
TX
01
BP10050385
PHYSICIAN IN TRAINING PERMIT NUMBER
TX
01
P01855287
MEDICARE RAIL ROAD
TX
01
P01855291
MCRR
TX
Enumeration date
05/12/2014
Last updated
07/21/2022
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