Individual
LESLIE WAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2400
(817) 735-0615
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2400
(817) 735-0615
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
023829
CT
2084P0800X
Psychiatry Physician
209098
MA
2084P0800X
Psychiatry Physician
Primary
F2020
TX
2084P0802X
Addiction Psychiatry Physician
023829
CT
2084P0802X
Addiction Psychiatry Physician
209098
MA
2084P0802X
Addiction Psychiatry Physician
F2020
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001238294
—
CT
05
—
204374701
—
TX
01
—
8X5119
BCBS
TX
01
—
P00998014
RAILROAD MEDICARE
TX
Enumeration date
09/25/2006
Last updated
08/09/2016
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