Provider Demographics
NPI:1104038041
Name:SMITH, ART GLENN (MD)
Entity Type:Individual
Prefix:
First Name:ART
Middle Name:GLENN
Last Name:SMITH
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 1:1000 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5007
Mailing Address - Country:US
Mailing Address - Phone:940-397-3140
Mailing Address - Fax:940-397-3150
Practice Address - Street 1:1000 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5007
Practice Address - Country:US
Practice Address - Phone:940-397-3140
Practice Address - Fax:940-397-3150
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH33442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE74414Medicare UPIN
TX83645KMedicare ID - Type UnspecifiedM.D.