Individual
JASON C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
113 BARRINGTON CT, MAPLE HILL, NC 28454-8659
(205) 908-2066
Mailing address
113 BARRINGTON CT, MAPLE HILL, NC 28454-8659
(205) 908-2066
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1290344375
UNITED STATES NAVY
—
Enumeration date
06/08/2020
Last updated
06/08/2020
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