Provider Demographics
NPI:1033177613
Name:SMITH, JEFFREY D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632572
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2572
Mailing Address - Country:US
Mailing Address - Phone:800-341-2666
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-872-2432
Practice Address - Fax:513-872-8857
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN178560367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000003794OtherANTHEM
IN200129720Medicaid
KY74455320Medicaid
OH0237470Medicaid
OH430030502OtherRR MEDICARE PALMETTO GBA