Basic Information
| Provider Information | |||||||||
| NPI: | 1184194193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCE S SMITH MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7451 CHAPEL AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761167090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172947444 | ||||||||
| FaxNumber: | 8172947172 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W RANDOL MILL RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760122504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175486100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | PANNEL | ||||||||
| AuthorizedOfficialFirstName: | CECE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFF MGR | ||||||||
| AuthorizedOfficialTelephone: | 8172947444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.