Provider Demographics
NPI:1366413098
Name:SMITH, KYLE (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:3604 LIVE OAK ST STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6114
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-826-6442
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2794207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2794OtherMEDICAL LICENSE
TX133780006Medicaid
TX8K2198Medicare PIN
LA4N478DH19Medicare PIN
TXA67670Medicare UPIN
LA5DG27/4N478DG27Medicare PIN
TX8F21302Medicare PIN