Individual
JEREMY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3310 RUNNELS ST, FORT WORTH, TX 76106-6421
(469) 237-8614
Mailing address
PO BOX 535822, GRAND PRAIRIE, TX 75053-5822
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/27/2016
Last updated
03/27/2016
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