Organization
TYLER OFFICE OF PEDIATRICS P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY P SMITH M.D. (OWNER/PHYSICIAN)
(903) 595-3220
Entity
Organization
Contact information
Practice address
4801 TROUP HWY, SUITE 301, TYLER, TX 75703-2356
(903) 595-3220
(903) 595-3887
Mailing address
PO BOX 131866, TYLER, TX 75713-1866
(903) 595-3220
(903) 595-3887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J4527
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043902803
—
TX
05
—
118586004
—
TX
Enumeration date
12/11/2007
Last updated
04/09/2012
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