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Individual

JEFF THOMAS SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
20 PROSPECT ST, BRIDGEPORT, OH 43912-1411
(304) 650-1767
Mailing address
20 PROSPECT ST, BRIDGEPORT, OH 43912-1411
(304) 650-1767

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
125553494
WV
05
1356607394
WV
05
1821206228
WV
Enumeration date
09/27/2023
Last updated
09/27/2023
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  • EDI platform