Provider Demographics
NPI:1386828655
Name:SMITH, TESSA EVETT (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:EVETT
Last Name:SMITH
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 1:607 OAKLEY ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5976
Mailing Address - Country:US
Mailing Address - Phone:912-441-2982
Mailing Address - Fax:
Practice Address - Street 1:607 OAKLEY ST
Practice Address - Street 2:UNIT 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5976
Practice Address - Country:US
Practice Address - Phone:912-441-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002227207P00000X
TXN2816207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA276OtherBCBSTX
TX202400201Medicaid
TX1386828655OtherTRICARE SOUTH
TX1386828655Medicare PIN
TXP00747428Medicare PIN
TX1386828655OtherTRICARE SOUTH