Provider Demographics
NPI:1801892187
Name:SMITH, ALEX JASON (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JASON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2107 COURTHOUSE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2355
Mailing Address - Country:US
Mailing Address - Phone:903-295-1938
Mailing Address - Fax:903-295-5902
Practice Address - Street 1:2107 COURTHOUSE DR STE 103
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2355
Practice Address - Country:US
Practice Address - Phone:903-295-1938
Practice Address - Fax:903-295-5902
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00435364OtherRR MEDICARE
TXP00435364OtherRR MEDICARE
TXG30096Medicare UPIN