Individual
DR. MERVYN P. SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE/DIVISION OF CARDIOLOGY, JACKSON, MS 39216-4500
(601) 984-5630
Mailing address
PO BOX 24146, UNIVERSITY PHYSICIANS PLLC, JACKSON, MS 39225-4146
(601) 984-5678
(601) 984-5638
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
07057
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01279231
—
MS
05
—
1627861
—
LA
01
—
P00462325
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/24/2006
Last updated
03/18/2009
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