Provider Demographics
NPI:1144239880
Name:SMITH, DOUGLAS K (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
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 1:101 BRETFORD CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5654
Mailing Address - Country:US
Mailing Address - Phone:210-587-6937
Mailing Address - Fax:210-579-1012
Practice Address - Street 1:101 BRETFORD CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5654
Practice Address - Country:US
Practice Address - Phone:210-587-6937
Practice Address - Fax:210-579-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK69312085R0202X
FLME959202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE30336Medicare UPIN