Provider Demographics
NPI:1194704312
Name:SMITH, JACQUELINE J (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-8445
Mailing Address - Fax:816-781-8413
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 402
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-8445
Practice Address - Fax:816-781-8413
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMD118130207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5177783OtherBCBS
MO204660609Medicaid
MOG95896Medicare UPIN