Provider Demographics
NPI:1740287838
Name:SMITH, ANGELA N (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E. FRONT
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8326
Mailing Address - Country:US
Mailing Address - Phone:903-596-0602
Mailing Address - Fax:903-596-0620
Practice Address - Street 1:820 E. FRONT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8326
Practice Address - Country:US
Practice Address - Phone:903-596-0602
Practice Address - Fax:903-596-0620
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80173828OtherRAILROAD MEDICARE
TX0094GCOtherBLUE CROSS/ BS
TX03106101Medicaid
TX0094GCOtherBLUE CROSS/ BS
TX03106101Medicaid