Provider Demographics
NPI:1629012000
Name:SMITH, BOBBY W (DO)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4206
Mailing Address - Country:US
Mailing Address - Phone:806-288-7891
Mailing Address - Fax:806-288-7920
Practice Address - Street 1:1605 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7834
Practice Address - Country:US
Practice Address - Phone:806-296-7881
Practice Address - Fax:806-288-7882
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015093208600000X
TXM4552208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI63102Medicare UPIN