Provider Demographics
NPI:1538116884
Name:SMELTZER, BARRY L (PA-C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:SMELTZER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-369-9856
Mailing Address - Fax:210-570-8020
Practice Address - Street 1:155 E SONTERRA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3987
Practice Address - Country:US
Practice Address - Phone:210-369-9856
Practice Address - Fax:210-570-8020
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001810363AS0400X
TXTX07115363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209119OtherMEDICARE PTAN LOCALITY 16
IL209118OtherMEDICARE PTAN LOCALITY 15
ILP71601Medicare UPIN
ILK13981Medicare PIN
IL209118OtherMEDICARE PTAN LOCALITY 15