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Individual

DR. JACK MICHAEL SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1100 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701
(570) 326-8457
(570) 320-7989
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900

Taxonomy

Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
MD463374
PA

Other

Enumeration date
05/26/2013
Last updated
07/17/2018
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