Provider Demographics
NPI:1457446510
Name:SMITH, CARLA B (DO)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:225 SE JOHN JONES DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8341
Practice Address - Country:US
Practice Address - Phone:817-447-0445
Practice Address - Fax:817-447-2273
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750369203OtherNPI GROUP NUMBER
TX8L16491Medicare PIN
TX1750369203OtherNPI GROUP NUMBER
TX00U87ZMedicare PIN