Provider Demographics
NPI:1093929150
Name:SMITH, MARCUS ANDREW (MD)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9600
Mailing Address - Street 2:DEPARTMENT 09-019
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-9600
Mailing Address - Country:US
Mailing Address - Phone:903-794-4196
Mailing Address - Fax:903-792-7408
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 302B
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5228
Practice Address - Country:US
Practice Address - Phone:903-794-4196
Practice Address - Fax:903-614-5190
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1153207T00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179117500OtherUS DEPARTMENT OF LABOR
AR85751OtherBLUE CROSS BLUE SHIELD OF ARKANSAS
TXP00738165OtherRAILROAD MEDICARE
AR178049001Medicaid
OK200258160AMedicaid
TX8L14510OtherINDIVIDUAL PTAN MEDICARE
TX1093929150OtherQUALCHOICE
1871793307OtherCIGNA DME#
TX203880401Medicaid
TXP02599421OtherRR MCR
TX1093929150OtherTRICARE- HUMANA MILITARY
1093929150OtherHUMANA MILITARY
TX1G2371OtherMEDICARE
TXMDN1153OtherTEXAS WORKERS' COMPENSATION