Provider Demographics
NPI:1609019934
Name:SMALLWOOD, NATHAN RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RYAN
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:425 N HIGHLAND AVE STE 130
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7383
Practice Address - Country:US
Practice Address - Phone:903-892-9179
Practice Address - Fax:903-868-2317
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3108207P00000X, 208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346152704Medicaid
TX346152703Medicaid
TX346152704Medicaid
TX346152703Medicaid