Provider Demographics
NPI:1881665149
Name:SMITH, KAREN ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:312 PEARL PKWY APT 4507
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1199
Mailing Address - Country:US
Mailing Address - Phone:210-429-4204
Mailing Address - Fax:
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER
Practice Address - Street 2:3551 ROGER BROOKE DRIVE
Practice Address - City:FT. SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78243-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2421
Practice Address - Fax:319-356-3900
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN46153208800000X
IA37281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55973OtherWELLMARK BCBS
IAI20500Medicare PIN
IAP00403815Medicare PIN
VAD000Medicare UPIN