Provider Demographics
NPI:1740382142
Name:SMITH, HARRY L (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:L
Last Name:SMITH
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 1:4400 S PIEDRAS DR
Mailing Address - Street 2:STE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1221
Mailing Address - Country:US
Mailing Address - Phone:210-735-7889
Mailing Address - Fax:210-735-3060
Practice Address - Street 1:4400 S PIEDRAS DR
Practice Address - Street 2:STE 140 HARRY L SMITH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1221
Practice Address - Country:US
Practice Address - Phone:210-735-7889
Practice Address - Fax:210-735-3060
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF20172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00D549Medicare ID - Type Unspecified
D97720Medicare UPIN