Healthcare Provider Details

I. General information

NPI: 1396057527
Provider Name (Legal Business Name): JARROD RUSSELL SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE STE 400
HUNTINGTON WV
25702-1236
US

IV. Provider business mailing address

PO BOX 4100
BARBOURSVILLE WV
25504-4100
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-6905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME 122891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30636
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: