Basic Information
| Provider Information | |||||||||
| NPI: | 1437203429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMOCK | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | HUNTER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 N PIEDRAS ST | ||||||||
| Address2: | WILLIAM BEAUMONT ARMY MEDICAL CENTER, ATTN CREDENTIA | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155692107 | ||||||||
| FaxNumber: | 9155691233 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 N PIEDRAS ST | ||||||||
| Address2: | WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN. CREDENTIALS | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155692107 | ||||||||
| FaxNumber: | 9155691233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 207X00000X | 2015021378 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 17977 | WI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | MO | MEDICAID | 17977 | 01 | WI | WI STATE LIC | OTHER |