Smith, Randy Wallace

Smith, Randy Wallace is an sole proprietor health care provider with primary practice located at 1602 Rock Prairie Rd #430, College Station TX 77845-8306. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Smith, Randy Wallace can be contacted via phone (979) 693-0737.

Contact Information

Primary practice address
1602 Rock Prairie Rd #430 College Station TX 77845-8306
Phone: (979) 693-0737
Fax: (979) 693-7442
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X G3802 Texas

Profile Details

NPI number 1235136938
LBN Legal business name Smith, Randy Wallace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 7th, 2005
Last updated Feb 14th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235136938 NPPES
Texas MEDICAID 115736401

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