Provider Demographics
NPI:1881686095
Name:SMITH, PAXTON J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAXTON
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-403-9500
Mailing Address - Fax:210-403-9523
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-403-9500
Practice Address - Fax:210-403-9523
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-05-16
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Provider Licenses
StateLicense IDTaxonomies
TXF4546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110682501Medicaid
TXC22005Medicare UPIN
TX110682501Medicaid