Provider Demographics
NPI:1558305490
Name:SMITH, ELLEN BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BLAIR
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1165
Practice Address - Country:US
Practice Address - Phone:512-419-9733
Practice Address - Fax:512-451-3709
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0313207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128726003Medicaid
TX8BP361OtherBCBS OF TX
TX128726006Medicaid
TX128726007Medicaid
TX0811853-01Medicaid
TX830004600OtherRAILROAD MEDICARE NUMBER
TX8BP361OtherBCBS OF TX
TXC21932Medicare UPIN
TX128726003Medicaid
TX8L1644Medicare PIN
TX0080BYMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER