Basic Information
| Provider Information | |||||||||
| NPI: | 1578547204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT H SMALLEY MDPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 CLUB VIEW DR | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789455709 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 CLUB VIEW DR | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789455709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134813533 | ||||||||
| FaxNumber: | 7134320221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | SMALLEY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7134813533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.