Individual
JORDAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11040 N STATE RD 77, HAYWARD, WI 54843
(715) 934-4910
(316) 665-6082
Mailing address
11040 N STATE RD 77, HAYWARD, WI 54843
(715) 934-4910
(316) 665-6082
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82812-20
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
82812-20
WI
Other
Enumeration date
06/25/2020
Last updated
09/11/2024
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