Provider Demographics
NPI:1184829764
Name:OOMMEN, SMITHA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITHA
Middle Name:ELIZABETH
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:STE 1104
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3000
Mailing Address - Country:US
Mailing Address - Phone:409-347-8870
Mailing Address - Fax:409-347-8878
Practice Address - Street 1:3560 DELAWARE ST STE 1104
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3000
Practice Address - Country:US
Practice Address - Phone:409-347-8870
Practice Address - Fax:409-554-0016
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-002628207R00000X
TXN7853207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3858306738OtherMYUTMB 3858306738-COMMERCIAL NUMBER