Provider Demographics
NPI:1124431275
Name:SMITH, JESSE RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1924 ALCOA HIGHWAY
Mailing Address - Street 2:BUILDING D, SUITE 362
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-305-4670
Mailing Address - Fax:865-305-4671
Practice Address - Street 1:1924 ALCOA HIGHWAY
Practice Address - Street 2:BUILDING D, SUITE 362
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-306-4670
Practice Address - Fax:865-305-4671
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2021-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY3033812086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty