Provider Demographics
NPI:1053594911
Name:DR. CYNTHIA SWAYZE SMITH D.O
Entity type:Organization
Organization Name:DR. CYNTHIA SWAYZE SMITH D.O
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWAYZE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-360-6787
Mailing Address - Street 1:7777 FOREST LN BLDG C SUITE A94
Mailing Address - Street 2:PMB 138
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:469-360-6787
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN BLDG C SUITE A94
Practice Address - Street 2:PMB 138
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:469-360-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165161401Medicaid
TX154379502Medicaid
TX154379502Medicaid
TX165161401Medicaid