Individual
JONATHAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4548 CLERMONT AVE, GROVES, TX 77619-3014
(409) 626-1427
Mailing address
4548 CLERMONT AVE, GROVES, TX 77619-3014
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
333616
TX
Other
Enumeration date
06/05/2022
Last updated
06/06/2022
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