Provider Demographics
NPI:1346807583
Name:SMITH, STEPHEN LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16333 VANCE JACKSON APT 1112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5087
Mailing Address - Country:US
Mailing Address - Phone:360-531-0241
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1679
Practice Address - Country:US
Practice Address - Phone:210-699-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692019213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist