Provider Demographics
NPI:1386607398
Name:SMART, KENNETH RAY JR (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:SMART
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4401 COIT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0500
Mailing Address - Country:US
Mailing Address - Phone:972-334-0400
Mailing Address - Fax:972-334-0510
Practice Address - Street 1:4401 COIT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0500
Practice Address - Country:US
Practice Address - Phone:972-334-0400
Practice Address - Fax:972-334-0510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8195208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI10695Medicare UPIN
TX8C0875Medicare ID - Type Unspecified