Provider Demographics
NPI:1144385063
Name:SMITH, THOMAS GENE (GNP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 GESSNER RD # 127
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-6320
Mailing Address - Country:US
Mailing Address - Phone:713-204-8016
Mailing Address - Fax:
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:713-204-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568565363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX568565OtherNURSING
TXNP7242OtherBLUE CROSS BLUE SHIELD
TX094081904Medicaid
TXNP7242OtherBLUE CROSS BLUE SHIELD
TX094081904Medicaid