Provider Demographics
NPI:1093809261
Name:SMITH, JUDE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDE
Other - Middle Name:T
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:535 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-0141
Mailing Address - Fax:716-372-6421
Practice Address - Street 1:535 MAIN ST.
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-0141
Practice Address - Fax:716-372-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054531207X00000X, 2086S0120X
NY118818207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0654706Medicaid
A16749Medicare UPIN
SM4017691Medicare ID - Type Unspecified