Provider Demographics
NPI:1548219371
Name:SMITH, MAHALIA DOROTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHALIA
Middle Name:DOROTHY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 1.246
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-704-5908
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN, MSB 1.246
Practice Address - Street 2:DEPT OF CARDIOLOGY, DIVISION OF HYPERBARIC MEDICINE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-704-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163678901Medicaid
TXG09985Medicare UPIN
TX163678901Medicaid