Provider Demographics
NPI:1235498908
Name:SMITH, JEFFREY BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRIAN
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:PO BOX 1000
Mailing Address - Street 2:DEPT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-523-2945
Mailing Address - Fax:901-523-8488
Practice Address - Street 1:51 N DUNLAP ST
Practice Address - Street 2:SUITE 410
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-523-2945
Practice Address - Fax:901-523-8488
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics