Provider Demographics
NPI:1053370031
Name:SMITH HARRISON, LEON ISMAEL (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:ISMAEL
Last Name:SMITH HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3533 S ALAMEDA ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-4700
Mailing Address - Fax:361-694-4701
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-4700
Practice Address - Fax:361-694-4701
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF57552088P0231X
AZ34133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103799Medicare UPIN
AZ117604Medicare PIN
AZC36729Medicare UPIN