Provider Demographics
NPI:1902817448
Name:SMITH, JAMES MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MORRIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3115 PINE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3201
Mailing Address - Country:US
Mailing Address - Phone:254-752-9621
Mailing Address - Fax:752-752-8378
Practice Address - Street 1:3115 PINE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3201
Practice Address - Country:US
Practice Address - Phone:254-752-9621
Practice Address - Fax:752-752-8378
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9665207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D73470Medicare UPIN
TX8G2758Medicare PIN