Healthcare Provider Details

I. General information

NPI: 1457579112
Provider Name (Legal Business Name): JEFFREY FRANK SMITH LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

IV. Provider business mailing address

3957 PURDUE LN
ABILENE TX
79602-8408
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-3865
  • Fax: 325-793-1295
Mailing address:
  • Phone: 325-795-2918
  • Fax: 325-793-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: