Provider Demographics
NPI:1528078714
Name:SMELTER, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:SMELTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 EAST CARTWRIGHT, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:214-320-7600
Mailing Address - Fax:972-329-1400
Practice Address - Street 1:820 EAST CARTWRIGHT, SUITE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:214-320-7600
Practice Address - Fax:214-320-7690
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057595207Q00000X
TXP5004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057595Medicaid
IL14D0435769OtherCLIA
IL6394POtherCATERPILLAR
IL101738OtherHEALTHLINK
IL133586700OtherACS-OWCP
IL08421024OtherBC/BS
IL232889OtherPERSONAL CARE
ILP00194441OtherRR MEDICARE PIN
IL103476OtherHEALTH ALLIANCE
IL036057595OtherIL STATE LICENSE
IL020057300OtherBLACK LUNG
ILCD7143OtherRR MEDICARE GROUP
TXP5004OtherMEDICAL LICENSE
IL6394POtherCATERPILLAR