Provider Demographics
NPI:1316051527
Name:SMITH, EILEEN A (MD PA)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34567
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265
Mailing Address - Country:US
Mailing Address - Phone:210-967-0515
Mailing Address - Fax:210-655-9697
Practice Address - Street 1:8601 VILLAGE DRIVE
Practice Address - Street 2:#118
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-967-0515
Practice Address - Fax:210-655-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXJ11412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099920303Medicaid
TXP00079579OtherMEDICARE RAILROAD (PTAN)
TX8R7170OtherBCBS
TX099920302Medicaid
TX099920302Medicaid
TX8D1905Medicare PIN
TX099920303Medicaid