Provider Demographics
NPI:1790725083
Name:SMITH, MERYLE DOROTHY (CRNA)
Entity Type:Individual
Prefix:
First Name:MERYLE
Middle Name:DOROTHY
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140430
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0430
Mailing Address - Country:US
Mailing Address - Phone:214-522-0210
Mailing Address - Fax:214-522-0474
Practice Address - Street 1:803 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4535
Practice Address - Country:US
Practice Address - Phone:972-875-0900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX514500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology