Provider Demographics
NPI:1598848798
Name:SMITH, QUINTIN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:QUINTIN
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4012 NORTH LAMAR BV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3714
Mailing Address - Country:US
Mailing Address - Phone:512-454-3624
Mailing Address - Fax:512-454-1287
Practice Address - Street 1:4012 NORTH LAMAR BV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3714
Practice Address - Country:US
Practice Address - Phone:512-454-3624
Practice Address - Fax:512-454-1287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2599207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099351101Medicaid
TX099351101Medicaid
B26528Medicare UPIN