Individual
JAMIE MICHELLE WALLACE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
107 1ST ST NE, MOUNT VERNON, IA 52314-1422
(319) 895-1620
Mailing address
107 1ST ST NE, MOUNT VERNON, IA 52314-1422
(319) 895-1620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39137
IA
207Q00000X
Family Medicine Physician
R8646
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013144674
—
IA
Enumeration date
06/22/2009
Last updated
11/06/2024
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