Provider Demographics
NPI:1679535553
Name:SMEDLEY, JONATHAN G (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
Last Name:SMEDLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPGS STE 1150
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4310
Mailing Address - Country:US
Mailing Address - Phone:512-255-0125
Mailing Address - Fax:512-255-0153
Practice Address - Street 1:7200 WYOMING SPGS STE 1150
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4310
Practice Address - Country:US
Practice Address - Phone:512-255-0125
Practice Address - Fax:512-255-0153
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1664213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165612601Medicaid
TX8M2370OtherBCBS
TX165612601Medicaid
TX8M2370OtherBCBS