Provider Demographics
NPI:1164851457
Name:SMETANA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SMETANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 391
Mailing Address - Street 2:825 S MAIN ST
Mailing Address - City:TONOPAH
Mailing Address - State:NV
Mailing Address - Zip Code:89049-0391
Mailing Address - Country:US
Mailing Address - Phone:775-482-6233
Mailing Address - Fax:775-482-2480
Practice Address - Street 1:825 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:NV
Practice Address - Zip Code:89049-0391
Practice Address - Country:US
Practice Address - Phone:775-482-6233
Practice Address - Fax:775-482-2480
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant