Provider Demographics
NPI:1316928799
Name:SMITH, GREGORY W (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1768
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78296-1768
Mailing Address - Country:US
Mailing Address - Phone:956-542-1850
Mailing Address - Fax:956-542-2879
Practice Address - Street 1:1090 EAST ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-542-1850
Practice Address - Fax:956-542-2879
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CB205OtherBLUE CROSS BLUE SHIELD
TX6362570001OtherMEDICARE NSC
TX149890903OtherMEDICAID
TXP00017885OtherMEDICARE - RAILROAD
TX8F22500OtherMEDICARE