Provider Demographics
NPI:1063436590
Name:SMITH, JENNIFER REED (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REED
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5111 N SCOTTSDALE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7076
Mailing Address - Country:US
Mailing Address - Phone:602-224-9218
Mailing Address - Fax:602-224-0078
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7076
Practice Address - Country:US
Practice Address - Phone:602-224-9218
Practice Address - Fax:602-224-0078
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-08-17
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Provider Licenses
StateLicense IDTaxonomies
AZ3139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG73776Medicare UPIN