Provider Demographics
NPI:1013977800
Name:SMERNOFF, ERIC NATHAN (PH D)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NATHAN
Last Name:SMERNOFF
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 FOREST PARK RD STE BLA .110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5461
Mailing Address - Country:US
Mailing Address - Phone:214-648-4646
Mailing Address - Fax:214-645-3775
Practice Address - Street 1:6333 FOREST PARK RD STE BLA .110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5461
Practice Address - Country:US
Practice Address - Phone:214-648-4646
Practice Address - Fax:214-645-3775
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322812084N0600X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86847AOtherBCBS
TX1649311-01Medicaid
TX86847AOtherBCBS
TXQ12261Medicare UPIN
TXP00298810Medicare PIN