Provider Demographics
NPI:1336317486
Name:SUZANNE M SMITH, DPM, PA
Entity Type:Organization
Organization Name:SUZANNE M SMITH, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-412-1347
Mailing Address - Street 1:3136 HORIZON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7807
Mailing Address - Country:US
Mailing Address - Phone:972-412-1347
Mailing Address - Fax:972-463-1185
Practice Address - Street 1:3136 HORIZON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7807
Practice Address - Country:US
Practice Address - Phone:972-412-1347
Practice Address - Fax:972-463-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0899213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A0323Medicare PIN
TX4817980001Medicare NSC