Basic Information
| Provider Information | |||||||||
| NPI: | 1013977800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMERNOFF | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | NATHAN | ||||||||
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| Credential: | PH. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6333 FOREST PARK RD STE BLA .110 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752355461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146484646 | ||||||||
| FaxNumber: | 2146453775 | ||||||||
| Practice Location | |||||||||
| Address1: | 6333 FOREST PARK RD STE BLA .110 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752355461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146484646 | ||||||||
| FaxNumber: | 2146453775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0600X | 32281 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 103G00000X | 32281 | TX | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 86847A | 01 | TX | BCBS | OTHER | 1649311-01 | 05 | TX | MEDICAID |