Provider Demographics
NPI:1255381059
Name:SMITH, DEMETRIA M (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIA
Middle Name:M
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 1:6717 W ELDORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5635
Mailing Address - Country:US
Mailing Address - Phone:972-369-0744
Mailing Address - Fax:972-369-0644
Practice Address - Street 1:6717 W ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5635
Practice Address - Country:US
Practice Address - Phone:972-369-0744
Practice Address - Fax:972-369-0644
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH89125Medicare UPIN
TXTXB150051Medicare PIN
TXTXB150052Medicare PIN
TXTXB150050Medicare PIN