Provider Demographics
NPI:1124079009
Name:SMITH, JAY L (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4632
Mailing Address - Country:US
Mailing Address - Phone:419-531-5544
Mailing Address - Fax:419-531-5117
Practice Address - Street 1:1072 N MAIN ST
Practice Address - Street 2:BOWLING GREEN PAIN CLINIC
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402
Practice Address - Country:US
Practice Address - Phone:419-354-6166
Practice Address - Fax:419-354-6756
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044006208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547671Medicaid
C02737Medicare UPIN
OH0547671Medicaid