Provider Demographics
NPI:1063425155
Name:SMITH, WELDON LLOYD JR (MD)
Entity type:Individual
Prefix:DR
First Name:WELDON
Middle Name:LLOYD
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2016
Mailing Address - Country:US
Mailing Address - Phone:469-800-9000
Mailing Address - Fax:460-800-9150
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2016
Practice Address - Country:US
Practice Address - Phone:469-800-9000
Practice Address - Fax:460-800-9150
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-07-06
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Provider Licenses
StateLicense IDTaxonomies
TXE6625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87X746OtherBCBS
TX127865702Medicaid
TX87X746OtherBCBS
TX87X746Medicare PIN
TX110105983Medicare PIN