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General NPI Number Information
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NPI Number | 1215165469
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Entity Type | Individual
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Provider Name | JERRY B SMEDLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-227-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 439 SPRING MEADOWS DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7682
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Country | US
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Telephone | 208-932-2762
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | O-0655
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License Number State | ID
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