Provider Demographics
NPI:1083621866
Name:SMITH, PAMELA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
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 1:6200 SARATOGA BLVD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3478
Mailing Address - Country:US
Mailing Address - Phone:361-225-2255
Mailing Address - Fax:361-854-3672
Practice Address - Street 1:6200 SARATOGA BLVD UNIT 5
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3478
Practice Address - Country:US
Practice Address - Phone:361-225-2255
Practice Address - Fax:361-854-3672
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104109702Medicaid
TX84222KOtherBLUE CROSS BLUE SHIELD
TX110180216OtherRAILROAD MEDICARE
TX84222KOtherBLUE CROSS BLUE SHIELD
TX84222KMedicare PIN