Healthcare Provider Details

I. General information

NPI: 1437370806
Provider Name (Legal Business Name): JEFFREY DANIEL SMITHERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 E CREEKS EDGE DR
BLOOMINGTON IN
47401-8368
US

IV. Provider business mailing address

2605 E CREEKS EDGE DR
BLOOMINGTON IN
47401-8368
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-2663
  • Fax: 812-355-2310
Mailing address:
  • Phone: 812-333-2663
  • Fax: 812-349-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01075102A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01075102A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number01075102A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: