Organization
J SCOTT SMITH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY S SMITH MD (OWNER)
(817) 598-8120
Entity
Organization
Contact information
Practice address
1321 WATER'S EDGE DR. 1010-4, GRANBURY, TX 76048
(817) 598-8120
(682) 936-4323
Mailing address
1321 WATER'S EDGE DR. 1010-4, GRANBURY, TX 76048
(817) 598-8120
(682) 936-4323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K3476
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AN010
BLUE CROSS BLUE SHIELD
—
Enumeration date
12/14/2010
Last updated
11/11/2020
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