Healthcare Provider Details

I. General information

NPI: 1306850722
Provider Name (Legal Business Name): JERRY W SMARTT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 COMMERCE DR SUITE 412
CARMEL IN
46032-7640
US

IV. Provider business mailing address

9640 COMMERCE DR SUITE 412
CARMEL IN
46032-7640
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-4545
  • Fax: 317-872-3959
Mailing address:
  • Phone: 317-872-4545
  • Fax: 317-872-3959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01058330A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: