Provider Demographics
NPI:1386644953
Name:SMOLARZ, GREGORY J SR (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:SMOLARZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RIDGE
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 400
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5224
Practice Address - Country:US
Practice Address - Phone:903-614-5670
Practice Address - Fax:903-614-5674
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3725207X00000X
TXG0143207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103428001Medicaid
OK100145390AMedicaid
TX122489104Medicaid
AR83204OtherBCBS
TX122489104Medicaid