Healthcare Provider Details

I. General information

NPI: 1447089677
Provider Name (Legal Business Name): JACOB WILLIAM SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MAIN ST
NEWMARKET NH
03857-1843
US

IV. Provider business mailing address

207 S MAIN ST
NEWMARKET NH
03857-1843
US

V. Phone/Fax

Practice location:
  • Phone: 603-659-3106
  • Fax: 603-659-5892
Mailing address:
  • Phone: 603-659-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: