Provider Demographics
NPI:1437361334
Name:SMITH, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
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 1:1075 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2248
Mailing Address - Country:US
Mailing Address - Phone:864-583-7265
Mailing Address - Fax:864-591-0422
Practice Address - Street 1:1075 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2248
Practice Address - Country:US
Practice Address - Phone:864-583-7265
Practice Address - Fax:864-591-0422
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57011532208100000X
TXN6674208100000X
SCMD35262208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC352629Medicaid
TX8DB689OtherBCBS OF TEXAS
SCP01658235OtherRAILROAD MEDICARE
SCSC0171AMedicare PIN
SC352629Medicaid
SCSC01717830Medicare PIN