Provider Demographics
NPI:1619975380
Name:SMITH, ALBERT L (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-3521
Mailing Address - Country:US
Mailing Address - Phone:956-689-5506
Mailing Address - Fax:956-689-1988
Practice Address - Street 1:165 S 6TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3521
Practice Address - Country:US
Practice Address - Phone:956-689-5506
Practice Address - Fax:956-689-1988
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-08-10
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TXG0133207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130453703Medicaid
TX080018795OtherRAILROAD MEDICARE
TX00G640Medicare PIN
TXC22011Medicare UPIN
TX135927100OtherVALLEY BAPTIST HEALTH PLANS
TXTXB103090Medicare PIN
TX74-2591906OtherTRICARE (PGBA)
TX0299520001Medicare NSC
TX080018795OtherRAILROAD MEDICARE
TXTXB103091Medicare PIN
TX296279P01OtherCIGNA
TXC22011Medicare UPIN
TX00G640Medicare ID - Type Unspecified
TX1467601658Medicare NSC