Basic Information
| Provider Information | |||||||||
| NPI: | 1386644953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMOLARZ | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RIDGE | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822713 | ||||||||
| FaxNumber: | 4692820996 | ||||||||
| Practice Location | |||||||||
| Address1: | 2602 SAINT MICHAEL DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755035224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036145670 | ||||||||
| FaxNumber: | 9036145674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R3725 | AR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | G0143 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 103428001 | 05 | AR | MEDICAID | 100145390A | 05 | OK | MEDICAID | 122489104 | 05 | TX | MEDICAID | 83204 | 01 | AR | BCBS | OTHER |