Provider Demographics
NPI:1992373518
Name:SMITH, MARK ANGEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANGEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0001
Mailing Address - Country:US
Mailing Address - Phone:409-747-1883
Mailing Address - Fax:409-747-8579
Practice Address - Street 1:UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-747-1883
Practice Address - Fax:409-747-8579
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10077041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine