Individual
DR. JEFFREY P. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
214 E HOUSTON ST, TYLER, TX 75702-8131
(903) 535-9041
Mailing address
523 S FANNIN AVE, TYLER, TX 75702-8204
(903) 535-9041
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J4527
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0026MA
GROUP BC/BS
TX
01
—
00850X
GROUP MEDICARE
TX
05
—
118586004
—
TX
01
—
169940701
GROUP MEDICAID
TX
01
—
45D1034142
CLIA
TX
01
—
8R1210
BLUE CROSS BLUE SHIELD
TX
01
—
J4527
MEDICAL LICENSE
TX
Enumeration date
10/05/2006
Last updated
11/21/2024
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