Provider Demographics
NPI:1558561647
Name:SMITH, JASON P SR (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:P
Other - Last Name:SMITH
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3755 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9706
Mailing Address - Country:US
Mailing Address - Phone:304-562-1800
Mailing Address - Fax:304-562-0413
Practice Address - Street 1:3755 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9706
Practice Address - Country:US
Practice Address - Phone:304-562-1800
Practice Address - Fax:304-562-0413
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine