Provider Demographics
NPI:1518948926
Name:SMITH, GEORGE NORVELL (D O)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NORVELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1017
Mailing Address - Country:US
Mailing Address - Phone:254-826-5372
Mailing Address - Fax:254-826-5371
Practice Address - Street 1:500 MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1017
Practice Address - Country:US
Practice Address - Phone:254-826-5372
Practice Address - Fax:254-826-5371
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2167677OtherBLUE LINK
TXP000MK740Medicaid
TX00MK74Medicare ID - Type Unspecified
TXA67677Medicare UPIN