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General NPI Number Information
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NPI Number | 1417535360
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Entity Type | Individual
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Provider Name | JACOB ROBERT SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 201 W VAN ASCHE LOOP
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4996
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Country | US
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Telephone | 479-966-4491
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Fax | 479-966-4311
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-5148
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T9799
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-17976
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | E-17976
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License Number State | AR
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