Individual
RUSSELL R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5900 ALTAMESA BLVD STE 100, FORT WORTH, TX 76132-5475
(817) 854-9969
(817) 845-9965
Mailing address
5900 ALTAMESA BLVD STE 100, FORT WORTH, TX 76132-5475
(817) 854-9969
(817) 845-9965
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA05791
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283600901
—
TX
Enumeration date
07/29/2008
Last updated
05/22/2023
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