Provider Demographics
NPI:1306850722
Name:SMARTT, JERRY W JR (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:SMARTT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9640 COMMERCE DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7640
Mailing Address - Country:US
Mailing Address - Phone:317-872-4545
Mailing Address - Fax:317-872-3959
Practice Address - Street 1:9640 COMMERCE DR
Practice Address - Street 2:SUITE 412
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7640
Practice Address - Country:US
Practice Address - Phone:317-872-4545
Practice Address - Fax:317-872-3959
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01058330A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506690Medicaid
IN221710Medicare ID - Type Unspecified
I21963Medicare UPIN