Individual
JASON WAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 E CHESTNUT ST, SUITE 710, LOUISVILLE, KY 40202-5700
(502) 583-8303
(502) 584-0302
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0329
(502) 588-0326
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
41807
KY
2086S0102X
Surgical Critical Care Physician
Primary
41807
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100053850
—
KY
Enumeration date
05/16/2007
Last updated
10/17/2016
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