Provider Demographics
NPI:1326341090
Name:SMITH, JERRY DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DEE
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 1:310 SW COUNTY ROAD 1000
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-8600
Mailing Address - Country:US
Mailing Address - Phone:903-874-6140
Mailing Address - Fax:
Practice Address - Street 1:310 SW COUNTY ROAD 1000
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-8600
Practice Address - Country:US
Practice Address - Phone:903-874-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2087207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology