Provider Demographics
NPI:1316668338
Name:SMITH, EIAN JACOB I
Entity type:Individual
Prefix:
First Name:EIAN
Middle Name:JACOB
Last Name:SMITH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 S WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1945
Mailing Address - Country:US
Mailing Address - Phone:815-271-1188
Mailing Address - Fax:
Practice Address - Street 1:1816 S WOODLAND DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1945
Practice Address - Country:US
Practice Address - Phone:815-271-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty