Organization
UTMB FACULTY GROUP PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA L. SMITH (DIRECTOR)
(409) 772-2222
Entity
Organization
Contact information
Practice address
206 MIMMS AVE, NACOGDOCHES, TX 75961-5028
(936) 560-0515
(936) 560-1636
Mailing address
P O BOX 4797-710, HOUSTON, TX 77210-4797
(409) 772-2222
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207N00000X
Dermatology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109372602
—
TX
Enumeration date
06/09/2006
Last updated
09/22/2009
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