Provider Demographics
NPI:1578983771
Name:SMITH, AVERY
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 HICKORY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-268-4122
Mailing Address - Fax:
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-268-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9515207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty