Provider Demographics
NPI:1366820938
Name:SMART, JASON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 N 500 E STE 350
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2469
Mailing Address - Country:US
Mailing Address - Phone:435-752-7445
Mailing Address - Fax:435-753-3059
Practice Address - Street 1:1300 N 500 E STE 350
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2469
Practice Address - Country:US
Practice Address - Phone:435-752-7445
Practice Address - Fax:435-753-3059
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12068681-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1366820938Medicaid