Provider Demographics
NPI:1093737520
Name:SMITH, TONI L (PA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2950 CULLEN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3921
Mailing Address - Country:US
Mailing Address - Phone:281-412-6262
Mailing Address - Fax:281-412-6740
Practice Address - Street 1:2950 CULLEN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3921
Practice Address - Country:US
Practice Address - Phone:281-412-6262
Practice Address - Fax:281-412-6740
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA 02413363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69844Medicare UPIN
TX8G8687Medicare PIN
TX8F4134Medicare PIN