Individual
MR. JERRY M SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
4643 DOCK RD, BLDG 524, PORT HUENEME, CA 93043-4321
(805) 982-2411
Mailing address
10213 TRUETT LN, SAN DIEGO, CA 92124-3642
(360) 689-0241
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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