Provider Demographics
NPI:1285015990
Name:SMITH, JEREMY KEITH (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:KEITH
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 1:170 MANNING DR
Mailing Address - Street 2:PHYSICIANS OFFICE BLDG CB# 7594
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7594
Mailing Address - Country:US
Mailing Address - Phone:919-966-6442
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DR
Practice Address - Street 2:PHYSICIANS OFFICE BLDG CB# 7594
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7594
Practice Address - Country:US
Practice Address - Phone:919-966-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209737207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC209737OtherNORTH CAROLINA MEDICAL BOARD