Provider Demographics
NPI:1477555423
Name:SMOOT, JOHN BRANNAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRANNAN
Last Name:SMOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4107
Mailing Address - Country:US
Mailing Address - Phone:512-439-1000
Mailing Address - Fax:512-439-1081
Practice Address - Street 1:4700 SETON CENTER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4107
Practice Address - Country:US
Practice Address - Phone:512-439-1000
Practice Address - Fax:512-439-1081
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5211207X00000X, 207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0251OtherBC/BS
TX0293920-03Medicaid
TX0293920-02Medicaid
TXG90177Medicare UPIN
TX0366280002Medicare NSC
TX8L25933Medicare PIN
TX0366280008Medicare NSC
TX0366280005Medicare NSC
TX0366280004Medicare NSC
TX8K0251OtherBC/BS
TX0293920-02Medicaid
TX0293920-03Medicaid