Provider Demographics
NPI:1821191859
Name:SMITH, BRUCE KENDALL (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KENDALL
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 1:1626 HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008
Mailing Address - Country:US
Mailing Address - Phone:713-864-4128
Mailing Address - Fax:
Practice Address - Street 1:1315 ST. JOSEPH PKWY
Practice Address - Street 2:SUITE 940
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002
Practice Address - Country:US
Practice Address - Phone:713-659-2700
Practice Address - Fax:713-650-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2788208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58033Medicare UPIN
00J37BMedicare ID - Type Unspecified