Provider Demographics
NPI:1790881373
Name:SMITH, MICHAEL LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3345 PLAZA 10 DR
Mailing Address - Street 2:E
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2554
Mailing Address - Country:US
Mailing Address - Phone:409-838-2626
Mailing Address - Fax:409-838-1980
Practice Address - Street 1:3345 PLAZA 10 DR
Practice Address - Street 2:E
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2554
Practice Address - Country:US
Practice Address - Phone:409-838-2626
Practice Address - Fax:409-838-1980
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF7178207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138511413Medicaid
TXD69100Medicare UPIN
TX138511413Medicaid