Provider Demographics
NPI:1124015367
Name:SMITH, JEFFREY S (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1710
Mailing Address - Country:US
Mailing Address - Phone:724-852-2050
Mailing Address - Fax:724-627-7828
Practice Address - Street 1:734 E HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1710
Practice Address - Country:US
Practice Address - Phone:724-852-2050
Practice Address - Fax:724-627-7828
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004653-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE70569Medicare UPIN
PA145826Medicare ID - Type Unspecified