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Individual
MR. JASON ROBERT SMITH
Active
Individual
MR. JASON ROBERT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C5-0000717
DE
363A00000X
Physician Assistant
C50000717
DE
363AS0400X
Surgical Physician Assistant
25MP00161900
NJ
363AS0400X
Surgical Physician Assistant
Primary
MA052891
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00161900
NJ LICENSE
NJ
01
—
C5-0000717
DELAWARE DIVISION OF PROFESSIONAL REGULATION
DE
01
—
MA052891
PENNSYLANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
PA
Enumeration date
10/26/2006
Last updated
09/28/2016
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