Individual
DR. JACKSON BRUCE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 S 9TH ST, SUITE 600, PHILADELPHIA, PA 19107-6810
(215) 955-8430
(215) 923-5828
Mailing address
211 S 9TH ST, SUITE 600, PHILADELPHIA, PA 19107-6810
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD008957E
PA
207RR0500X
Rheumatology Physician
Primary
MD008957E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000793625
—
PA
05
—
1940805
—
NJ
Enumeration date
07/25/2006
Last updated
06/09/2014
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