MEDICARE: JAKE MICHAEL SMITH

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	208M00000X	Hospitalist Physician	330511	LA
2	207R00000X	Internal Medicine Physician	330511	LA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RC0000X	Cardiovascular Disease Physician	330511	LA

General Provider Information

NPI Number	:	1528528551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE MICHAEL SMITH

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-765-4050
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	7777 HENNESSY BLVD STE 1000
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4370
Country	:	US
Telephone Number	:	225-767-3900
Fax Number	:	225-766-2226

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	04/21/2026

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Directions to “ JAKE MICHAEL SMITH ” Practice Location

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