Provider Demographics
NPI:1396887691
Name:SMITH, ARCHIE DAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:DAN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5692
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78763-5692
Mailing Address - Country:US
Mailing Address - Phone:512-474-5244
Mailing Address - Fax:512-474-5244
Practice Address - Street 1:1215 RED RIVER
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1921
Practice Address - Country:US
Practice Address - Phone:512-479-3526
Practice Address - Fax:512-474-2720
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE8916207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E8916OtherCOMMERCIAL - LICENSE
000B56JOtherBLUE CROSS
C21992Medicare UPIN
B56JMedicare ID - Type Unspecified