Individual
DR. JACK E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5750 CENTRE AVE, SUITE 510, PITTSBURGH, PA 15206-3721
(412) 924-1100
(412) 924-1111
Mailing address
5750 CENTRE AVE, SUITE 510, PITTSBURGH, PA 15206-3709
(412) 924-1100
(412) 924-1111
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD034721E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00060300
HIGHMARK
PA
05
—
001042460006
—
PA
01
—
P00290974
RAILROAD MEDICARE
PA
Enumeration date
04/01/2006
Last updated
03/13/2014
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