Provider Demographics
NPI:1750309506
Name:SMITH, ROBERT B (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:SMITH
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:695 US HIGHWAY 46
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1592
Mailing Address - Country:US
Mailing Address - Phone:973-826-8080
Mailing Address - Fax:866-309-3354
Practice Address - Street 1:1400 CREEK WAY DR
Practice Address - Street 2:SUITE 201A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4072
Practice Address - Country:US
Practice Address - Phone:832-770-3180
Practice Address - Fax:888-248-5252
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-04-20
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Provider Licenses
StateLicense IDTaxonomies
TXPA02366363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181633201Medicaid
TX8N3694OtherBCBS
TXS85321Medicare UPIN
TX181633201Medicaid