Provider Demographics
NPI:1558069054
Name:SMILEY, STEPHEN KYLE
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KYLE
Last Name:SMILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DTEPHEN
Other - Middle Name:KYLE
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KYLE SMILEY, MD
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10086042171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider