Provider Demographics
NPI:1295765741
Name:SMITH, TINSLEY GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:TINSLEY
Middle Name:GORDON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GORDON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 47
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4688
Mailing Address - Country:US
Mailing Address - Phone:281-351-7483
Mailing Address - Fax:281-351-9771
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 47
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4688
Practice Address - Country:US
Practice Address - Phone:281-351-7483
Practice Address - Fax:281-351-9771
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1141OtherBLUECROSS & BLUE SHIELD
TXD3403OtherLICENSE
TX8F1141OtherBLUECROSS & BLUE SHIELD