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General NPI Number Information
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NPI Number | 1194742791
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Entity Type | Individual
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Provider Name | JESSE E SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 923 PENNSYLVANIA AVE STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-2254
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Country | US
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Telephone | 817-806-4245
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Fax | 817-720-0094
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Provider Business Mailing Address
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Address Line | 923 PENNSYLVANIA AVE STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-2254
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Country | US
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Telephone | 817-806-4245
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Fax | 817-720-0094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | L1204
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License Number State | TX
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