Individual
MADELINE SHELBY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 BOLAND ST STE 211, FORT WORTH, TX 76107-1265
(817) 529-8485
Mailing address
111 BOLAND ST STE 211, FORT WORTH, TX 76107-1265
(817) 529-8485
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1111111111
NOTAPPLICABLE
—
Enumeration date
02/11/2022
Last updated
02/11/2022
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