Provider Demographics
NPI:1750489258
Name:SMITH, ZACHARY JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2420
Mailing Address - Country:US
Mailing Address - Phone:281-597-8555
Mailing Address - Fax:281-597-8473
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2420
Practice Address - Country:US
Practice Address - Phone:281-597-8555
Practice Address - Fax:281-597-8473
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R01091OtherBLUE CROSS BLUE SHIELD
TX174002901Medicaid
TX8R01091OtherBLUE CROSS BLUE SHIELD
TXH81648Medicare UPIN