Provider Demographics
NPI:1083609135
Name:SMITH, ROBERT SHAWN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SHAWN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 W LAS COLINAS BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-236-0096
Practice Address - Street 1:506 S NURSERY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3187
Practice Address - Country:US
Practice Address - Phone:972-573-3288
Practice Address - Fax:972-573-3291
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140309Medicare PIN
TXS06761Medicare UPIN
TX2807695-02Medicaid
TXS06761Medicare UPIN
TX8N8218OtherBCBS
8D3179Medicare ID - Type Unspecified