Individual
DR. JACK DALE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G37180
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G371800
BLUE SHIELD
CA
05
—
00G371800
—
CA
01
—
P00745248
MEDICARE RAILROAD CARRIER
CA
Enumeration date
06/29/2006
Last updated
05/24/2017
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