MEDICARE: DR. JASON P SMITH SR. DO

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	2366	WV

General Provider Information

NPI Number	:	1558561647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON P SMITH SR. DO

Provider Business Mailing Address
First Line	:	3755 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9706
Country	:	US
Telephone Number	:	304-562-1800
Fax Number	:	304-562-0413

Provider Business Practice Location Address
First Line	:	3755 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9706
Country	:	US
Telephone Number	:	304-562-1800
Fax Number	:	304-562-0413

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	04/17/2015

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