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Individual

MR. JESSE E SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
923 PENNSYLVANIA AVE, STE 100, FORT WORTH, TX 76104-2254
(817) 806-4245
(817) 720-0094
Mailing address
923 PENNSYLVANIA AVE, STE 100, FORT WORTH, TX 76104-2254
(817) 806-4245
(817) 720-0094

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
L1204
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00413563
RAILROAD MEDICARE
Enumeration date
07/17/2006
Last updated
08/12/2025
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