MEDICARE: DR. JEREMY S SMOLIK 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
1	2085R0202X	Diagnostic Radiology Physician	M9016	TX

General Provider Information

NPI Number	:	1518141910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY S SMOLIK MD

Provider Business Mailing Address
First Line	:	311 CAMDEN ST STE 208
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-2011
Country	:	US
Telephone Number	:	210-455-0167
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 CAMDEN ST STE 208
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-2011
Country	:	US
Telephone Number	:	210-455-0167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	10/11/2011

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