Healthcare Provider Details

I. General information

NPI: 1013753953
Provider Name (Legal Business Name): JESSE E SMITH, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 PENNSYLVANIA AVE STE 100
FORT WORTH TX
76104-2254
US

IV. Provider business mailing address

923 PENNSYLVANIA AVE STE 100
FORT WORTH TX
76104-2254
US

V. Phone/Fax

Practice location:
  • Phone: 817-806-4245
  • Fax: 817-720-0094
Mailing address:
  • Phone: 817-806-4245
  • Fax: 817-720-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE E. SMITH
Title or Position: OWNER
Credential: MD
Phone: 817-806-4245