Individual
DR. JACOB SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1300 HELICOPTER RD, VIRGINIA BEACH, VA 23459-8913
(757) 763-2007
Mailing address
NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DR, SAN DIEGO, CA 92134-5000
(541) 990-2091
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0102208723
VA
171000000X
Military Health Care Provider
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/08/2021
Last updated
12/02/2024
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