MEDICARE: JONATHAN G SMEDLEY DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1664	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8M2370	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679535553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN G SMEDLEY DPM

Provider Business Mailing Address
First Line	:	7200 WYOMING SPGS STE 1150
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4310
Country	:	US
Telephone Number	:	512-255-0125
Fax Number	:	512-255-0153

Provider Business Practice Location Address
First Line	:	7200 WYOMING SPGS STE 1150
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4310
Country	:	US
Telephone Number	:	512-255-0125
Fax Number	:	512-255-0153

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	02/18/2011

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