Provider Demographics
NPI:1861526741
Name:SMITH, CYNTHIA L (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2838
Mailing Address - Country:US
Mailing Address - Phone:800-859-9269
Mailing Address - Fax:337-332-6071
Practice Address - Street 1:6247 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-2838
Practice Address - Country:US
Practice Address - Phone:800-859-9269
Practice Address - Fax:337-332-6071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2594208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004DTOtherBLUE CROSS BLUE SHIELD
TX096629301Medicaid
TX250012463OtherRAILROAD MEDICARE
TX367193YLPFMedicare PIN
TX250012463OtherRAILROAD MEDICARE