Individual
JACOB SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 W CHINDEN BLVD, MERIDIAN, ID 83646-6690
(208) 809-2860
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 985-1399
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-13867
ID
207Q00000X
Family Medicine Physician
MRM-1467
ID
Other
Enumeration date
05/29/2015
Last updated
07/14/2021
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