Provider Demographics
NPI:1083006670
Name:SMITH, JASON T (CSFA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 BEARBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1677
Mailing Address - Country:US
Mailing Address - Phone:346-715-9098
Mailing Address - Fax:
Practice Address - Street 1:4419 BEARBERRY AVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1677
Practice Address - Country:US
Practice Address - Phone:281-691-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical