Provider Demographics
NPI:1558308650
Name:SMITH, JEANETTE L (MD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 W PARKER RD
Mailing Address - Street 2:#410
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7939
Mailing Address - Country:US
Mailing Address - Phone:972-981-8380
Mailing Address - Fax:972-981-3234
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:#410
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-981-8380
Practice Address - Fax:972-981-3234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics