Provider Demographics
NPI:1043338478
Name:SMITH, EARL EDGAR III (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:EDGAR
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1150 N LOOP 1604 W
Mailing Address - Street 2:SUITE 108, #622
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4500
Mailing Address - Country:US
Mailing Address - Phone:210-479-8659
Mailing Address - Fax:210-479-8694
Practice Address - Street 1:1150 N LOOP 1604 W
Practice Address - Street 2:SUITE 108, #622
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4500
Practice Address - Country:US
Practice Address - Phone:210-479-8659
Practice Address - Fax:210-479-8694
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF0003207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97738Medicare UPIN