Provider Demographics
NPI:1750355442
Name:SMITH, SCOTT H (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5002 LAKELAND CIR
Mailing Address - Street 2:STE A
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2976
Mailing Address - Country:US
Mailing Address - Phone:254-752-2571
Mailing Address - Fax:254-752-0699
Practice Address - Street 1:5002 LAKELAND CIR
Practice Address - Street 2:STE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2976
Practice Address - Country:US
Practice Address - Phone:254-752-2571
Practice Address - Fax:254-752-0699
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
TXH9572207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034690702Medicaid
TX8124MOMedicare PIN
TX034690702Medicaid
TX0980370001Medicare NSC