Provider Demographics
NPI:1437203429
Name:SMOCK, PATRICK HUNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:HUNTER
Last Name:SMOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER, ATTN CREDENTIA
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-2107
Mailing Address - Fax:915-569-1233
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN. CREDENTIALS
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-2107
Practice Address - Fax:915-569-1233
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
171000000X
MO2015021378207X00000X
WI17977207X00000X
MN61668207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
WI17977OtherWI STATE LIC
MO132300596Medicare PIN