Provider Demographics
NPI:1477611960
Name:SMITH, ROBERT GLENN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:SMITH
Suffix:
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 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-3780
Mailing Address - Fax:713-790-6468
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 802
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-3780
Practice Address - Fax:713-790-6468
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH20082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EY670OtherBLUE CROSS BLUE SHIELD
TXP01511158OtherRR MEDICARE
TX157791803Medicaid
TX157791801Medicaid
TX157791803Medicaid
TXE48701Medicare UPIN