Provider Demographics
NPI:1073579462
Name:SMYER, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:SMYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 FRANKFORD AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:US
Mailing Address - Phone:806-368-9631
Mailing Address - Fax:806-368-9633
Practice Address - Street 1:10210 FRANKFORD AVE
Practice Address - Street 2:STE 310
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-368-9631
Practice Address - Fax:806-368-9633
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31606Medicare UPIN
8450K1Medicare ID - Type Unspecified
8450K1Medicare ID - Type Unspecified