=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689587875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYA SMITH-JONES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 N SWIFT RD
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60101-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-751-5783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5960 NW 55TH LN
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-2419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11042834
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------