Individual
DR. BERT JACKSON SMITH
Active
Individual
DR. BERT JACKSON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101256885
VA
207R00000X
Internal Medicine Physician
43425
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497839070
—
NC
05
—
1497839070
—
VA
05
—
1506626
—
TN
05
—
1506627
—
TN
05
—
5913158
—
NC
05
—
7100075230
—
KY
01
—
P00844330
RR MEDICARE
TN
05
—
Q002701
—
TN
Enumeration date
10/24/2006
Last updated
06/04/2024
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