Provider Demographics
NPI:1306023114
Name:SMETANICK, MATTHEW THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SMETANICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4513 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1302
Mailing Address - Country:US
Mailing Address - Phone:512-930-3909
Mailing Address - Fax:512-869-5868
Practice Address - Street 1:200 JOHN HOOVER PKWY
Practice Address - Street 2:BLDG 4, SUITE B
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611
Practice Address - Country:US
Practice Address - Phone:512-930-3909
Practice Address - Fax:512-869-5868
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014480207N00000X
TXN4111207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN4111OtherTX MEDICAL LICENSE