Provider Demographics
NPI:1407293947
Name:THOMAS FUGATE SMITH MD PA
Entity Type:Organization
Organization Name:THOMAS FUGATE SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:512-732-2774
Mailing Address - Street 1:PO BOX 202110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-2110
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:855-959-1863
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:STE G201
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-732-2774
Practice Address - Fax:512-329-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty