Provider Demographics
NPI:1255397394
Name:SMITH, RENEE C
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:HORNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2451 S FM 51
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3858
Mailing Address - Country:US
Mailing Address - Phone:940-626-8008
Mailing Address - Fax:940-627-4709
Practice Address - Street 1:2451 S FM 51
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3858
Practice Address - Country:US
Practice Address - Phone:940-626-8008
Practice Address - Fax:940-627-4709
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6649207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1580OtherBCBS
TX162806701Medicaid
H98117Medicare UPIN
TX162806701Medicaid