Individual
JUSTIN G SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
132 5TH AVE W, SUITE 1, JEROME, ID 83338-1825
(208) 814-9800
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-12489
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851612600
—
ID
Enumeration date
06/16/2010
Last updated
09/05/2014
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