Provider Demographics
NPI:1740382084
Name:SMITH, FERRIL CHRIS (MD)
Entity Type:Individual
Prefix:MR
First Name:FERRIL
Middle Name:CHRIS
Last Name:SMITH
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 1:4104 REYNOSA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739
Mailing Address - Country:US
Mailing Address - Phone:512-750-0019
Mailing Address - Fax:512-520-5589
Practice Address - Street 1:4104 REYNOSA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739
Practice Address - Country:US
Practice Address - Phone:512-750-0019
Practice Address - Fax:512-520-5589
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097241602Medicaid
00A52TMedicare ID - Type Unspecified