Provider Demographics
NPI:1518141910
Name:SMOLIK, JEREMY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:SMOLIK
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 1:311 CAMDEN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2011
Mailing Address - Country:US
Mailing Address - Phone:210-455-0167
Mailing Address - Fax:
Practice Address - Street 1:311 CAMDEN ST STE 208
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2011
Practice Address - Country:US
Practice Address - Phone:210-455-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM90162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology