Individual
JERROLD R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 E WASHINGTON ST, SUITE 200, INDIANAPOLIS, IN 46219-6803
(317) 355-7171
(317) 355-9022
Mailing address
6626 E. 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01021574A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000711341
ANTHEM
IN
05
—
100056310
—
IN
Enumeration date
06/10/2005
Last updated
03/09/2015
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