Individual
JEREME STEPHEN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
440 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4631
(906) 776-9040
(906) 774-5950
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007871
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1137621
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
—
01
—
4679-23
WISCONSIN DRL LICENSE
WI
Enumeration date
09/07/2016
Last updated
03/18/2020
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