Healthcare Provider Details

I. General information

NPI: 1316575657
Provider Name (Legal Business Name): JONATHAN COLBY SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 TROUP HWY
TYLER TX
75701-7101
US

IV. Provider business mailing address

6 RIVERSIDE PL
TEXARKANA TX
75503-9455
US

V. Phone/Fax

Practice location:
  • Phone: 903-510-7006
  • Fax:
Mailing address:
  • Phone: 903-826-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberV2278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: