| Dr Jeffrey P Smith, MD | |
|
214 E Houston St, Tyler, TX 75702-8131 | |
| (903) 535-9041 | |
| Not Available |
| Full Name | Dr Jeffrey P Smith |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 214 E Houston St, Tyler, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760578835 | NPI | - | NPPES |
| 45D1034142 | Other | TX | CLIA |
| J4527 | Other | TX | MEDICAL LICENSE |
| 00850X | Other | TX | GROUP MEDICARE |
| 0026MA | Other | TX | GROUP BC/BS |
| 118586004 | Medicaid | TX | |
| 169940701 | Other | TX | GROUP MEDICAID |
| 8R1210 | Other | TX | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | J4527 (Texas) | Primary |
| Entity Name | Tyler Family Circle of Care |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144575820 PECOS PAC ID: 4587812888 Enrollment ID: O20120911000666 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jeffrey P Smith, MD 523 S Fannin Ave, Tyler, TX 75702-8204 Ph: (903) 535-9041 | Dr Jeffrey P Smith, MD 214 E Houston St, Tyler, TX 75702-8131 Ph: (903) 535-9041 |
Krystal Castle, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 305 W Rusk St, Tyler, TX 75701 Phone: 903-592-7304 |
Daniel Jun Park, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 8288 S Broadway Ave, Tyler, TX 75703 Phone: 903-606-7060 Fax: 903-606-7129 |
Mrs. Valerie B Smith, MD Pediatrics Medicare: May Accept Medicare Assignments Practice Location: 1350 E Richards St, Tyler, TX 75702 Phone: 903-531-9455 Fax: 903-526-3118 |
Dr. Juwairriyyah Abdul Wahid Siddiqui, MD Pediatrics Medicare: May Accept Medicare Assignments Practice Location: 8934 S Broadway Ave Ste 448, Tyler, TX 75703 Phone: 903-606-5100 Fax: 903-606-5105 |
Ms. Yanique Tavia Ellis, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2900 North Broadway Ave, Tyler, TX 75702 Phone: 903-593-1892 |
Kristina Orey Mitchell, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1000 E 5th St Ste 100, Tyler, TX 75701 Phone: 903-596-3862 Fax: 903-590-5005 |
Adelina G. Meadows, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 8934 S Broadway Ave Ste 448, Tyler, TX 75703 Phone: 903-606-5100 Fax: 903-606-5105 |