Provider Demographics
NPI:1558474148
Name:SMITH, RANDLOW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDLOW
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2016
Mailing Address - Country:US
Mailing Address - Phone:214-823-4800
Mailing Address - Fax:214-823-4801
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2016
Practice Address - Country:US
Practice Address - Phone:214-823-4800
Practice Address - Fax:214-823-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87X758OtherBCBS
TX124196001Medicaid
TX124196001Medicaid
TXC21920Medicare UPIN
TX87X758OtherBCBS