Provider Demographics
NPI:1891732590
Name:SMITH, RALEIGHARNOLDIII (MD)
Entity Type:Individual
Prefix:
First Name:RALEIGHARNOLDIII
Middle Name:
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:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78335-1268
Mailing Address - Country:US
Mailing Address - Phone:361-758-0327
Mailing Address - Fax:361-758-7986
Practice Address - Street 1:1401 W WHEELER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4522
Practice Address - Country:US
Practice Address - Phone:361-758-0327
Practice Address - Fax:361-758-7986
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4547207P00000X, 208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098381903Medicaid
UT$$$$$$$$$Medicare PIN
C21999Medicare UPIN