Provider Demographics
NPI:1033138102
Name:SMITH, ERIC BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:STE 830
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-826-6235
Practice Address - Fax:214-828-4633
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM3741208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187108601Medicaid
TXP00476750OtherRR MEDICARE
TX8J2861Medicare PIN
TXP00476750OtherRR MEDICARE