Provider Demographics
NPI:1962454397
Name:SMITH, KIM L (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 JUNCTION DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5006
Mailing Address - Country:US
Mailing Address - Phone:214-547-8300
Mailing Address - Fax:214-547-9787
Practice Address - Street 1:865 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5006
Practice Address - Country:US
Practice Address - Phone:214-547-8300
Practice Address - Fax:214-547-9787
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist