Provider Demographics
NPI:1922004233
Name:SMITH, MARK C (MD, FACS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5337
Mailing Address - Country:US
Mailing Address - Phone:972-665-4700
Mailing Address - Fax:972-665-4710
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:STE 240
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5337
Practice Address - Country:US
Practice Address - Phone:972-665-4700
Practice Address - Fax:972-665-4710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK7617208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002345Medicare ID - Type Unspecified
TXG90923Medicare UPIN