Provider Demographics
NPI:1063701431
Name:SMITH, JASON E (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5631
Mailing Address - Country:US
Mailing Address - Phone:406-422-5905
Mailing Address - Fax:406-422-5425
Practice Address - Street 1:400 SADDLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5631
Practice Address - Country:US
Practice Address - Phone:406-422-5905
Practice Address - Fax:406-422-5425
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTRAINING LICPENDING213ES0103X
MT33559213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery