Individual
PAM J. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 847556, DALLAS, TX 75284-7556
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
234402
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84442U
BLUE SHIELD
TX
01
—
P00204103
RR/MEDICARE
TX
Enumeration date
04/07/2006
Last updated
07/10/2007
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