Basic Information
| Provider Information | |||||||||
| NPI: | 1447235908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMOLENS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7142 SAN PEDRO AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106615622 | ||||||||
| FaxNumber: | 2107986811 | ||||||||
| Practice Location | |||||||||
| Address1: | 2391 NE LOOP 410 | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782175600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106547326 | ||||||||
| FaxNumber: | 2105908232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | F2937 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 118940902 | 05 | TX | MEDICAID | 390001942 | 01 | TX | MEDICARE RAILROAD | OTHER |