Individual
JEFFREY D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
7979 W RIFLEMAN ST, BOISE, ID 83704-9066
(208) 989-0598
Mailing address
PO BOX 8985, BOISE, ID 83707-2985
(208) 989-0598
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
PA383
ID
363A00000X
Physician Assistant
Primary
PA-383
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806233100
—
ID
Enumeration date
10/07/2005
Last updated
09/12/2016
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