Provider Demographics
NPI:1104841188
Name:SMITH, JEFFERY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:247-875-4263
Mailing Address - Fax:217-872-5481
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 215
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:247-875-4263
Practice Address - Fax:217-872-5481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360982761207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05832033OtherBLUE CROSS BLUE SHIELD
IL388802OtherHEALTHLINK
ILP00048412OtherRAILROAD MEDICARE
IL0360982761Medicaid
IL388802OtherHEALTHLINK
ILP00048412OtherRAILROAD MEDICARE
IL0360982761Medicaid