Provider Demographics
NPI:1174530513
Name:SMART, DANNY R (MD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:R
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1651 ROCK PRAIRIE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8652
Mailing Address - Country:US
Mailing Address - Phone:979-680-0361
Mailing Address - Fax:
Practice Address - Street 1:1651 ROCK PRAIRIE RD
Practice Address - Street 2:STE 100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-680-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00075702OtherPALMETTO RAILROAD MCARE
TX8K0090OtherBLUE CROSS BLUE SHIELD
TX098840403Medicaid
TX8K0090OtherBLUE CROSS BLUE SHIELD
8B1195Medicare PIN