Provider Demographics
NPI:1184194193
Name:LANCE S SMITH MD PA
Entity Type:Organization
Organization Name:LANCE S SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFF MGR
Authorized Official - Prefix:
Authorized Official - First Name:CECE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-294-7444
Mailing Address - Street 1:7451 CHAPEL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7090
Mailing Address - Country:US
Mailing Address - Phone:817-294-7444
Mailing Address - Fax:817-294-7172
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty