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General NPI Number Information
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NPI Number | 1831787431
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Entity Type | Individual
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Provider Name | JACOB SMITH DO
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Gender | Male
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1300 HELICOPTER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23459-8913
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Country | US
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Telephone | 757-763-2007
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-5000
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Country | US
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Telephone | 541-990-2091
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0102208723
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License Number State | VA
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