Provider Demographics
NPI:1093929150
Name:SMITH, MARCUS ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9600
Mailing Address - Street 2:DEPARTMENT 09-019
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-9600
Mailing Address - Country:US
Mailing Address - Phone:903-794-4196
Mailing Address - Fax:903-792-7408
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 302B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5228
Practice Address - Country:US
Practice Address - Phone:903-794-4196
Practice Address - Fax:903-614-5190
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1153174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871793307OtherCIGNA DME#
OK200258160AMedicaid
TXMDN1153OtherTEXAS WORKERS' COMPENSATION
TXP00738165OtherRAILROAD MEDICARE
TX1093929150OtherTRICARE- HUMANA MILITARY
TX1093929150OtherQUALCHOICE
AR85751OtherBLUE CROSS BLUE SHIELD OF ARKANSAS
AR178049001Medicaid
TXP02599421OtherRR MCR
TX1G2371OtherMEDICARE
TX8L14510OtherINDIVIDUAL PTAN MEDICARE
TX179117500OtherUS DEPARTMENT OF LABOR
1093929150OtherHUMANA MILITARY
TX203880401Medicaid