Individual
DR. JACK W. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5111 LEESBURG PIKE, SKYLINE 5, SUITE 601, FALLS CHURCH, VA 22041-3251
(703) 681-1708
Mailing address
3556 EARLY WOODLAND PL, FAIRFAX, VA 22031-4732
(703) 425-7764
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101033705
VA
207Q00000X
Family Medicine Physician
ME 51346
FL
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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