Provider Demographics
NPI:1003091661
Name:SMITH, STACEY LANELL (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LANELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1355 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4915
Mailing Address - Country:US
Mailing Address - Phone:214-237-1664
Mailing Address - Fax:214-237-1864
Practice Address - Street 1:1600 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-848-4040
Practice Address - Fax:817-848-4870
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN5409207ZP0102X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology