Provider Demographics
NPI:1689853368
Name:SMITH, LANDON ENSIGN (MD)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:ENSIGN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:830-387-5270
Mailing Address - Fax:830-387-5329
Practice Address - Street 1:555 CREEKSIDE XING
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2594
Practice Address - Country:US
Practice Address - Phone:830-387-5270
Practice Address - Fax:830-387-5329
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN4760207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215519406Medicaid
TX215519406Medicaid