Provider Demographics
NPI:1508827007
Name:SMITH, EARL C JR (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:C
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:320 S POLK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1426
Mailing Address - Country:US
Mailing Address - Phone:806-376-5511
Mailing Address - Fax:806-376-8953
Practice Address - Street 1:320 S POLK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1426
Practice Address - Country:US
Practice Address - Phone:806-376-5511
Practice Address - Fax:806-376-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD7603207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089587201Medicaid
TX00P767Medicare PIN
D69104Medicare UPIN