Basic Information
| Provider Information | |||||||||
| NPI: | 1942497870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | SHAUN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6431 FANNIN STREET | ||||||||
| Address2: | MSB 7.005B | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007570 | ||||||||
| FaxNumber: | 7135000660 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST STE 1014 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770305301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257080 | ||||||||
| FaxNumber: | 7135122239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 2084N0600X | R1657 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 8GN641 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |