Provider Demographics
NPI:1669474912
Name:SMITH, LAURETTE NASRAT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURETTE
Middle Name:NASRAT
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURETTE
Other - Middle Name:NASRAT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12201 RENFERT WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5369
Mailing Address - Country:US
Mailing Address - Phone:512-339-6626
Mailing Address - Fax:512-425-3809
Practice Address - Street 1:1120 COTTONWOOD CREEK TRL STE 180B
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6652
Practice Address - Country:US
Practice Address - Phone:512-827-3438
Practice Address - Fax:512-623-7301
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7899207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044521502Medicaid
TXK7899OtherSTATE LICENSE
TX1669474912OtherNPI