Provider Demographics
NPI:1417416389
Name:SMITH, JASON TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TIMOTHY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROOKIN ST # 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5019
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:407-518-3923
Practice Address - Street 1:6500 ROOKIN ST # 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5019
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:713-559-3255
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1503872084P0804X, 2084P0800X
TXV45002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry