Basic Information
| Provider Information | |||||||||
| NPI: | 1598714719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITHERS | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 SUNSET RIDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750320007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727725450 | ||||||||
| FaxNumber: | 9727725452 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 SUNSET RIDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750320007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727725450 | ||||||||
| FaxNumber: | 9727725452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3132 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1529910-01 | 05 | TX | MEDICAID | 152990106 | 05 | TX | MEDICAID | 080187294 | 01 | TX | RR MEDICARE | OTHER |