MEDICARE: JASON T. SMOTHERMAN 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	208800000X	Urology Physician	18095	OK
2	208800000X	Urology Physician	16183	HI
3	208800000X	Urology Physician	60976	AZ

General Provider Information

NPI Number	:	1457315301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON T. SMOTHERMAN M.D.

Provider Business Mailing Address
First Line	:	4892 N STONE AVE STE 140
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5729
Country	:	US
Telephone Number	:	520-833-5200
Fax Number	:	520-318-7101

Provider Business Practice Location Address
First Line	:	6565 E CARONDELET DR STE 155
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3587
Country	:	US
Telephone Number	:	520-849-8900
Fax Number	:	520-849-7137

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

Provider Enumeration Date	:	04/15/2006
Last Update Date	:	11/13/2023

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