Individual
WILLIE SMITH II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1612 CHACON CANYON DR, DESOTO, TX 75115-7782
(817) 704-9583
Mailing address
1612 CHACON CANYON DR, DESOTO, TX 75115-7782
(817) 704-9583
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
02039054
TX
343900000X
Non-emergency Medical Transport (VAN)
Primary
02039054
TX
Other
Enumeration date
10/02/2024
Last updated
10/04/2024
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