Provider Demographics
NPI:1427139658
Name:SMITH, ROBERT NORWOOD JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NORWOOD
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6426
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0426
Mailing Address - Country:US
Mailing Address - Phone:817-293-7022
Mailing Address - Fax:817-551-9280
Practice Address - Street 1:11803 SOUTH FREEWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-293-7022
Practice Address - Fax:817-551-9280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD97719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0981508-02Medicaid
TXD97719Medicare UPIN
00EH70Medicare PIN