Provider Demographics
NPI:1568403699
Name:SMITH, ROY BASCOM (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:BASCOM
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-790-1818
Mailing Address - Fax:713-790-7500
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-790-1818
Practice Address - Fax:713-790-7500
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE2862207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741660214OtherHEALTH NEW ENGLAND
TX8FE194OtherBLUE CROSS BLUE SHIELD
TX125477305Medicaid
TX200016148OtherMEDICARE RAILROAD
TX2960776OtherCIGNA
TX1254773-02Medicaid
TXP01556981OtherRR MEDICARE
TX843084OtherBCBS
TX125477306Medicaid
TX4211561OtherAETNA US HEALTHCARE
TX1254773-02Medicaid
TX343413YUD8Medicare PIN
TXC21918Medicare UPIN