Healthcare Provider Details

I. General information

NPI: 1437361334
Provider Name (Legal Business Name): JEFFREY SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

IV. Provider business mailing address

1075 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-7265
  • Fax: 864-591-0422
Mailing address:
  • Phone: 864-583-7265
  • Fax: 864-591-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number57011532
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN6674
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD35262
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: