Provider Demographics
NPI:1053687970
Name:SMITH, HOLLY BENTZ (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BENTZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17183 I H 45 S STE 530
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3314
Mailing Address - Country:US
Mailing Address - Phone:936-270-3844
Mailing Address - Fax:936-271-2787
Practice Address - Street 1:17183 I H 45 S STE 530
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:936-270-3844
Practice Address - Fax:936-271-2787
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0135207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10046699OtherTEXAS STATE BOARD