Provider Demographics
NPI:1528281722
Name:SMITH, MONTE KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:KEITH
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11155 MARSH WREN CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-8741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11937 US HIGHWAY 271
Practice Address - Street 2:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER TYLER
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-3154
Practice Address - Country:US
Practice Address - Phone:903-877-7272
Practice Address - Fax:903-877-2805
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH8413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF41874Medicare UPIN