Provider Demographics
NPI:1952314767
Name:SMITH, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 PALUXY RD STE E
Mailing Address - Street 2:STE 201
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5689
Mailing Address - Country:US
Mailing Address - Phone:817-578-8910
Mailing Address - Fax:817-578-8911
Practice Address - Street 1:1308 PALUXY RD STE 201E
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-578-8910
Practice Address - Fax:817-578-8911
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2819207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI48245Medicare UPIN