Provider Demographics
NPI:1013141209
Name:SMITH, JASON TODD (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1117 MCLAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3500
Mailing Address - Country:US
Mailing Address - Phone:870-523-9100
Mailing Address - Fax:870-523-9107
Practice Address - Street 1:1117 MCLAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3500
Practice Address - Country:US
Practice Address - Phone:870-523-9100
Practice Address - Fax:870-523-9107
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1894213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V756Medicare PIN