MEDICARE: JAMIE MICHELLE WALLACE SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	39137	IA
2	207Q00000X	Family Medicine Physician	R8646	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013144674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MICHELLE WALLACE SMITH M.D.

Provider Business Mailing Address
First Line	:	326 HILLVIEW DR SE
Second Line	:
City	:	MOUNT VERNON
State	:	IA
Zip	:	52314-9719
Country	:	US
Telephone Number	:	319-361-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 1ST ST NE
Second Line	:
City	:	MOUNT VERNON
State	:	IA
Zip	:	52314-1422
Country	:	US
Telephone Number	:	319-895-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	10/22/2024

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