MEDICARE: MR. JEREMY SCOTT SMITH MD

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	207P00000X	Emergency Medicine Physician	M0573	TX
2	207Q00000X	Family Medicine Physician	M0573	TX

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	:	1275594848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY SCOTT SMITH MD

Provider Business Mailing Address
First Line	:	3618 N. UNIVERSITY DRIVE
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965
Country	:	US
Telephone Number	:	936-205-9922
Fax Number	:	936-205-9923

Provider Business Practice Location Address
First Line	:	3614 N UNIVERSITY DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2539
Country	:	US
Telephone Number	:	936-205-9922
Fax Number	:	936-205-9923

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/27/2018

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