MEDICARE: JEFFREY D SMITH PA C

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	207X00000X	Orthopaedic Surgery Physician	PA383	ID
2	363A00000X	Physician Assistant	PA-383	ID

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	:	1013905793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D SMITH PA C

Provider Business Mailing Address
First Line	:	PO BOX 8985
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83707-2985
Country	:	US
Telephone Number	:	208-989-0598
Fax Number	:

Provider Business Practice Location Address
First Line	:	7979 W RIFLEMAN ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9066
Country	:	US
Telephone Number	:	208-989-0598
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	09/12/2016

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Directions to “ JEFFREY D SMITH PA C” Practice Location

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