MEDICARE: DR. JENNIFER EMILY 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	MD00039281	WA

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	:	1215919170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER EMILY SMITH M.D.

Provider Business Mailing Address
First Line	:	4700 POINT FOSDICK DR STE 220
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-851-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 POINT FOSDICK DR STE 220
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-851-5121
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/19/2021

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