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NPI Code Detail

MEDICARE: MR. JESSE E SMITH MD

MEDICARE: MR. JESSE E SMITH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology PhysicianL1204TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00413563OTHERRAILROAD MEDICARE

General Provider Information

NPI Number : 1194742791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JESSE E SMITH MD
Provider Business Mailing Address
First Line : 923 PENNSYLVANIA AVE
Second Line : STE 100
City : FORT WORTH
State : TX
Zip : 76104-2254
Country : US
Telephone Number : 817-806-4245
Fax Number : 817-720-0094
Provider Business Practice Location Address
First Line : 923 PENNSYLVANIA AVE
Second Line : STE 100
City : FORT WORTH
State : TX
Zip : 76104-2254
Country : US
Telephone Number : 817-806-4245
Fax Number : 817-720-0094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 08/12/2025

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Directions to “ MR. JESSE E SMITH MD” Practice Location

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