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General NPI Number Information
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NPI Number | 1154624195
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Entity Type | Organization
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Legal Business Name | J SCOTT SMITH MD PA
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 1321 WATER'S EDGE DR. 1010-4
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City | GRANBURY
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State | TX
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Zip | 76048
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Country | US
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Telephone | 817-598-8120
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Fax | 682-936-4323
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Provider Business Mailing Address
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Address Line | 1321 WATER'S EDGE DR. 1010-4
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City | GRANBURY
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State | TX
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Zip | 76048
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Country | US
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Telephone | 817-598-8120
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Fax | 682-936-4323
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY S SMITH
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Credential | MD
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Telephone | 817-598-8120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K3476
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License Number State | TX
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