Doctor Name: | RUSSELL ALAN SMITH |
NPI Number: | 1346594439 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R. EP T., C.N.I.M. |
License Number: | 2557 |
Business Practice Address: | 33518 Haley Rd #1 Waller, TX - 774845110 |
Business Phone Number: | 8327416248 |
Business Fax Number: | 8883442947 |
Mailing Address: | 33518 Haley Rd, #1 WALLER |
State: | TX |
Postal Code: | 774845110 |
Phone Number: | 8327416248 |
Fax Number: | 8883442947 |
NPI Enumeration Date: | 10/29/2012 |
NPI Last Update Date: | 10/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246ZE0600X |
License Number: | 2557 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | Electroneurodiagnostic |
Taxonomy Definition: |